Provider Demographics
NPI:1659466779
Name:MILWAUKEE SKIN CENTER,S.C.
Entity Type:Organization
Organization Name:MILWAUKEE SKIN CENTER,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-355-2405
Mailing Address - Street 1:7400 W BROWN DEER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2078
Mailing Address - Country:US
Mailing Address - Phone:414-355-2405
Mailing Address - Fax:414-355-6460
Practice Address - Street 1:7400 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2078
Practice Address - Country:US
Practice Address - Phone:414-355-2405
Practice Address - Fax:414-355-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27925207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31392100Medicaid
WI31392100Medicaid
WIB51522Medicare UPIN