Provider Demographics
NPI:1114092368
Name:PARKINSON DERMATOLOGY SC
Entity Type:Organization
Organization Name:PARKINSON DERMATOLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-635-3766
Mailing Address - Street 1:114 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-9687
Mailing Address - Country:US
Mailing Address - Phone:715-635-3766
Mailing Address - Fax:715-635-3711
Practice Address - Street 1:114 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-9687
Practice Address - Country:US
Practice Address - Phone:715-635-3766
Practice Address - Fax:715-635-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36649020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32487000Medicaid
WI32487000Medicaid