Healthcare Provider Details

I. General information

NPI: 1245342633
Provider Name (Legal Business Name): DERMATOLOGY & SKIN SURGERY ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 183RD ST
TINLEY PARK IL
60477-3932
US

IV. Provider business mailing address

7151 183RD ST
TINLEY PARK IL
60477-3932
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-3530
  • Fax: 708-478-3537
Mailing address:
  • Phone: 708-478-3530
  • Fax: 708-478-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036073727
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036109235
License Number StateIL

VIII. Authorized Official

Name: DR. DONNA M STOCKTON
Title or Position: PRESIDENT
Credential: MD
Phone: 708-478-3530