Provider Demographics
NPI:1730193152
Name:SHORELINE SKIN SPECIALISTS, S.C.
Entity type:Organization
Organization Name:SHORELINE SKIN SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOYS
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:TAUSCHECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:920-457-3376
Mailing Address - Street 1:1414 N TAYLOR DR
Mailing Address - Street 2:SUITE 144
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1988
Mailing Address - Country:US
Mailing Address - Phone:920-457-3376
Mailing Address - Fax:920-458-6510
Practice Address - Street 1:1414 N TAYLOR DR
Practice Address - Street 2:SUITE 144
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1988
Practice Address - Country:US
Practice Address - Phone:920-457-3376
Practice Address - Fax:920-458-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23885-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty