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General NPI Number Information
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NPI Number | 1437273083
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTERS, SC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 183 HERITAGE DR
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-8042
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Country | US
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Telephone | 815-455-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 738 W NORTHWEST HWY
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City | BARRINGTON
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State | IL
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Zip | 60010-2640
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Country | US
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Telephone | 847-382-5111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID P VAN DAM
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Credential | MD
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Telephone | 847-382-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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