Provider Demographics
NPI:1700802923
Name:SCARLETT, DEBRA RENAE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:RENAE
Last Name:SCARLETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-298-7100
Practice Address - Fax:414-298-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI51384207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700802923Medicaid
WI004673645Medicare PIN
WI004673645Medicare PIN