Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Great Lakes Dermatology

Organization Procedural Dermatology Physician · NPI 1205041688

Great Lakes Dermatology is a Procedural Dermatology Physician in Pleasant Prairie, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2007.

Licensed in
WI
In the registry since
2007

Practice location Address checks out

9555 76th St Ste 2600
Pleasant Prairie, WI 53158-1984
Phone: (800) 485-8640
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Procedural Dermatology Physician (primary) Taxonomy 207NS0135X (WI)

Record details

NPI number1205041688
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Cathy Dean — Administrator · (800) 485-8640
NPI enumeratedMay 11, 2007
Last updated in NPPESAugust 22, 2020
Mailing address9555 76th St, Suite 2600, Pleasant Prairie, WI 53158-1984