Healthcare Provider Details

I. General information

NPI: 1891920898
Provider Name (Legal Business Name): ILLINOIS DERMATOLOGY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 SKOKIE BLVD SUITE J.
SKOKIE IL
60077-1384
US

IV. Provider business mailing address

903 COMMERCE DR STE 302
OAK BROOK IL
60523-8830
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-9711
  • Fax:
Mailing address:
  • Phone: 847-769-3539
  • Fax: 708-671-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH A. LOPATKA
Title or Position: PRESIDENT
Credential: MD
Phone: 708-218-5874