Healthcare Provider Details

I. General information

NPI: 1194225268
Provider Name (Legal Business Name): UNITED SKIN SPECIALISTS ILLINOIS LTD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 S WATER TOWER PL
MOUNT VERNON IL
62864-6293
US

IV. Provider business mailing address

33 E 33RD ST FL 12
NEW YORK NY
10016-5362
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-0031
  • Fax:
Mailing address:
  • Phone: 212-283-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC S SCHWEIGER
Title or Position: CEO
Credential: MD
Phone: 212-283-3000