Provider Demographics
NPI:1558944504
Name:FOREFRONT DERMATOLOGY, S.C.
Entity Type:Organization
Organization Name:FOREFRONT DERMATOLOGY, S.C.
Other - Org Name:THE DERM, A FOREFRONT DERMATOLOGY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-663-9022
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2601 COMPASS RD STE 125
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8089
Practice Address - Country:US
Practice Address - Phone:847-843-3376
Practice Address - Fax:847-998-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty