Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Dec 8, 2005
License(s)
69739-20 (WI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1610 MAXWELL DR STE 210 | Hudson, WI 54016-4004 | 715-386-4004 |
| MAILING | 801 YORK ST | Manitowoc, WI 54220-4630 | 920-663-9008 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.