GREAT LAKES DERMATOLOGY
NPI 1558576322
Dermatology - Procedural Dermatology in Kenosha, WI

Q: What is Great Lakes Dermatology's NPI number?

The NPI number for Great Lakes Dermatology is 1558576322. It was assigned to this organization in the NPPES registry on May 14, 2007.

Q: What is Great Lakes Dermatology's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.

Active since May 14, 2007

3601 30TH AVE, SUITE 210, KENOSHA, WI 53144(262) 658-2594 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Great Lakes Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES DERMATOLOGY (NPI 1558576322) is a healthcare organization registered as a procedural dermatology in Kenosha, Wisconsin and active in the NPI registry since May 2007. The organization lists Cathy Dean, Administrator, as its authorized official.

NPPES Registry Identity

NPI1558576322

Entity TypeOrganization

Primary Taxonomy207NS0135X

Legal Business NameGREAT LAKES DERMATOLOGY

Location Address3601 30TH AVE, SUITE 210Kenosha, WI 53144-1695

Mailing Address3610 30th Avenue, Suite 210Kenosha, WI 53144

Phone(262) 658-2594

Organization SubpartNo

Authorized OfficialCathy DeanAdministrator · (800) 485-8640

Enumeration DateMay 14, 2007

Last NPPES UpdateAugust 22, 2020

✔ NPI 1558576322 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Procedural DermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207NS0135X

Definition

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).

3601 30TH AVE, Kenosha, WI 53144

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINDSAY B.N. LAUBMEIER PT

Physical Therapist

3601 30TH AVE, SUITE 103
KENOSHA, WI 53144

Kenosha County (262) 657-7071

KAREN BETH STRAKA OTR, M.S.

Occupational Therapist

3601 30TH AVE, SUITE 103
KENOSHA, WI 53144

Kenosha County (262) 657-7071

REGINA CAPELLI-SCHEIDT M.D,S.C

General Practice

3601 30TH AVE
KENOSHA, WI 53144

Kenosha County (262) 658-8862

JOHN R CLAUSSEN PA-C

Physician Assistant

3601 30TH AVE, SUITE 201
KENOSHA, WI 53144

Kenosha County (262) 898-4400

CHAD T MIKESELL PT

Physical Therapist

3601 30TH AVE, SUITE 103
KENOSHA, WI 53144

Kenosha County (262) 657-7071

JENA LYNN DELISLE DPT

Physical Therapist

3601 30TH AVE, SUITE 103
KENOSHA, WI 53144

Kenosha County (262) 657-7071

AMTUL R AHMAD MD SC

Pediatrics

3601 30TH AVE, SUITE #101
KENOSHA, WI 53144

Kenosha County (262) 564-0611

FAMILY PEDIATRICS, INC.

Clinic/Center (Primary Care)

3601 30TH AVE
KENOSHA, WI 53144

Kenosha County (262) 564-0611

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Dermatology's NPI number?

The NPI number for Great Lakes Dermatology is 1558576322. It was assigned to this organization in the NPPES registry on May 14, 2007.

Where is Great Lakes Dermatology located?

Great Lakes Dermatology is located at 3601 30th Ave Suite 210, Kenosha, WI 53144. The listed phone number is (262) 658-2594.

What is Great Lakes Dermatology's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.

When was this NPI record last updated?

The NPPES record for Great Lakes Dermatology was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.