DR. MICHAEL JAMES SMULLEN MD NPI 1023020120

NPI Information

NPI: 1023020120
Provider Name: DR. MICHAEL JAMES SMULLEN, MD
Classification: Dermatology - 207ND0900X
Entity Type: Individual

Specialization: Dermatopathology

Address:
1239 W MASON ST
GREEN BAY, WI
ZIP 54303
Phone: (920) 499-0696
Get Directions

DR. Michael James Smullen, MD is a dermatopathology dermatology in Green Bay, WI. The provider is a dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. DR. Michael James Smullen, MD NPI is 1023020120. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1239 W MASON ST
GREEN BAY, WI
ZIP 54303-047
Phone: (920) 499-0696
Fax: (920) 499-0697

The enumeration date for this NPI number is 8/13/2006 and was last updated on 9/22/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207N00000X	Dermatology		WI16879	WISCONSIN	No
2	207ND0900X	Dermatology	Dermatopathology	WI16879	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	B56727	MEDICARE UPIN
2	30979400	MEDICAID	WISCONSIN
3	07052	MEDICARE ID-TYPE UNSPECIFIED	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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