GREAT LAKES DERMATOLOGY NPI 1558576322

NPI Information

  • NPI: 1558576322
  • Provider Name: GREAT LAKES DERMATOLOGY
  • Classification: Dermatology - 207NS0135X
  • Specialization: Procedural Dermatology
  • Entity Type: Organization
  • Address: 3601 30TH AVE
    SUITE 210
    KENOSHA, WI
    ZIP 53144
  • Phone: (262) 658-2594

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NPI Details

GREAT LAKES DERMATOLOGY is a procedural dermatology dermatology in Kenosha, WI. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). GREAT LAKES DERMATOLOGY NPI is 1558576322. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3601 30TH AVE
SUITE 210
KENOSHA, WI
ZIP 53144-695
Phone: (262) 658-2594

The provider's authorized official is Cathy Dean .
The authorized official title is Administrator and has the following contact phone number (800) 485-8640.

The enumeration date for this NPI number is 5/14/2007 and was last updated on 8/22/2020.

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
1207NS0135XDermatologyProcedural DermatologyWISCONSINYes

What is NPI?

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This page was last updated on: 11/21/2025

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