Dermatology Clinic S.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY CLINIC S.C.

Practice address

715 Superior Rd Ste 120
Green Bay, WI 54311-7595

Phone

(920) 406-9803

Fax

(920) 406-9934

NPI assigned

Jul 22, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Chris L Zimmermann, PHD

Title

Assistant to the President

Phone

(920) 406-9803

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Kolleen L Zimmermann, M.D.

  • Dermatology Physician
  • Green Bay, WI
  • NPI 1619981164
  NPD (past)

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1427079516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SUPERIOR RD STE 120",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543117595",
            "telephone_number": "920-406-9803",
            "fax_number": "920-406-9934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SUPERIOR RD STE 120",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543117595",
            "telephone_number": "920-406-9803",
            "fax_number": "920-406-9934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CLINIC S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMANN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ASSISTANT TO THE PRESIDENT",
        "authorized_official_telephone_number": "920-406-9803",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2187-023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21251100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin R Depouw, AUD
• Jane E Deprey, SAC-IT
• Melissa A Dercks, APNP
• Danna Anne Derenne, APNP
• Ann T Derge, BSN, RN-C, APNP
• Paul Herbert Dernehl, DDS
• Ahmet Dervish, MD
• Amy Des Forge, MS, LPC
• Ashley Desanctis, BCBA
• Heidi L Destree, MA

• 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 Apr 19, 2012; 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.