North Shore Dermatology, S.c.

NPI #1649399080 in Mequon, Wisconsin

Provider Information

NPI Number: 1649399080
Entity Type: Organization
Organization Name: North Shore Dermatology, S.c.
Primary Specialty: Dermatology
Enumeration Date: Mar 28, 2007
Last Updated: Aug 31, 2007

Practice Location

Address: 10303 N PORT WASHINGTON RD
Address 2: SUITE 101
City: Mequon
State: Wisconsin
ZIP Code: 53092-5760
Phone: (262) 240-0440

Authorized Official

Name: ANTHONY BONFIGLIO, MD
Title: OWNER PHYSICIAN
Phone: (262) 240-0440

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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