Healthcare Provider Details

I. General information

NPI: 1003425836
Provider Name (Legal Business Name): DOLEHIDE DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 SILVER CROSS BLVD SUITE 150
NEW LENOX IL
60451
US

IV. Provider business mailing address

1851 SILVER CROSS BLVD STE 150
NEW LENOX IL
60451-9629
US

V. Phone/Fax

Practice location:
  • Phone: 815-215-8292
  • Fax: 815-215-8289
Mailing address:
  • Phone: 815-215-8292
  • Fax: 815-215-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: CONOR PATRICK DOLEHIDE
Title or Position: OWNER
Credential: MD
Phone: 815-215-8292