Smullen, Michael James

Smullen, Michael James is an sole proprietor health care provider with primary practice located at 1239 W Mason St , Green Bay WI 54303-2047. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatopathology is his primary health care specialty. Smullen, Michael James can be contacted via phone (920) 499-0696.

Contact Information

Primary practice address
1239 W Mason St Green Bay WI 54303-2047
Phone: (920) 499-0696
Fax: (920) 499-0697
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X WI16879 Wisconsin
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X WI16879 Wisconsin

Profile Details

NPI number 1023020120
LBN Legal business name Smullen, Michael James
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 13th, 2006
Last updated Sep 22nd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023020120 NPPES
Wisconsin MEDICAID 30979400

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