Provider Demographics
NPI:1649399080
Name:NORTH SHORE DERMATOLOGY, S.C.
Entity Type:Organization
Organization Name:NORTH SHORE DERMATOLOGY, S.C.
Other - Org Name:DRS. MEISTER AND BONFIGLIO, S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONFIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-240-0440
Mailing Address - Street 1:10303 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5760
Mailing Address - Country:US
Mailing Address - Phone:262-240-0440
Mailing Address - Fax:262-240-0441
Practice Address - Street 1:10303 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5760
Practice Address - Country:US
Practice Address - Phone:262-240-0440
Practice Address - Fax:262-240-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty