Michael James Smullen, MD

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

WI16879 Issued in WI

Practice address

1239 W Mason St
Green Bay, WI 54303-2047

Phone

(920) 499-0696

Fax

(920) 499-0697

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael J. Smullen, MD

  • Dermatology Physician
  • Green Bay, WI
  • NPI 1194148379
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1023020120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032047",
            "telephone_number": "920-499-0696",
            "fax_number": "920-499-0697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032047",
            "telephone_number": "920-499-0696",
            "fax_number": "920-499-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMULLEN",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "WI16879",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "WI",
            "license": "WI16879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30979400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas J Smith, MD
• Zach Smith
• Christina L Smits, PT
• Erica Smits, PT
• George H Smullen, DDS
• Stephanie R Smullen, PA-C
• Riley A Smyth, M.D.
• Ronan H Smyth, MD
• Laura Snyder, ATS
• Matthew L Snyder, MD

• Dermatopathology Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Dermatopathology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.