Provider Demographics
NPI:1386630861
Name:DERMATOLOGY ASSOCIATES SC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEFEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-271-2721
Mailing Address - Street 1:324 E WISCONSIN AVE
Mailing Address - Street 2:#925
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4300
Mailing Address - Country:US
Mailing Address - Phone:414-271-2721
Mailing Address - Fax:414-271-3436
Practice Address - Street 1:324 E WISCONSIN AVE
Practice Address - Street 2:#925
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4300
Practice Address - Country:US
Practice Address - Phone:414-271-2721
Practice Address - Fax:414-271-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23129207N00000X
WI33345207N00000X
WI38666207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty