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General NPI Number Information
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NPI Number | 1255358289
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Entity Type | Organization
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Legal Business Name | CENTER FOR DERMATOLOGY AND SKIN CANCER LTD
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 2500 S HIGHLAND AVE SUITE 200
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City | LOMBARD
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State | IL
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Zip | 60148-5363
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Country | US
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Telephone | 630-964-2000
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Fax | 630-964-6378
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Provider Business Mailing Address
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Address Line | 2500 S HIGHLAND AVE SUITE 200
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City | LOMBARD
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State | IL
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Zip | 60148-5363
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Country | US
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Telephone | 630-964-2000
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Fax | 630-964-6378
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT VICTOR KOLBUSZ
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Credential | M.D
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Telephone | 630-964-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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