Michael J. Smullen, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MICHAEL J. SMULLEN, MD

Practice address

1239 W Mason St
Green Bay, WI 54303-2047

Phone

(920) 499-0696

Fax

(920) 499-0697

NPI assigned

Jan 24, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Michael J. Smullen, M.D.NPI 1023020120

Title

Solo Practitioner

Phone

(920) 499-0696

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael James Smullen, MD

  • Dermatopathology Physician
  • Green Bay, WI
  • NPI 1023020120

  Dermatology

  NPD (past) Authorized official

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1194148379",
    "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": {
        "organization_name": "MICHAEL J. SMULLEN, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "SMULLEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "SOLO PRACTITIONER",
        "authorized_official_telephone_number": "920-499-0696",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30979400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shamoon Mian, PA-C
• Mary Miceli-Wink, CSAC
• Rick D Miceli-Wink, CSAC
• Michael J Pierquet DDS SC
• Michael J. Mervilde,MSW
• Megan Michaelchuck
• Anthony Peter Michalski
• Lawrence E Michalski, RPH
• Erin Michelfelder
• Peter B Michon, CRNA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.