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General NPI Number Information
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NPI Number | 1679695829
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF HINSDALE, S.C.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 333 CHESTNUT ST SUITE 202
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City | HINSDALE
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State | IL
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Zip | 60521-3247
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Country | US
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Telephone | 630-325-6880
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Fax | 630-325-5975
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Provider Business Mailing Address
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Address Line | 333 CHESTNUT ST SUITE 202
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City | HINSDALE
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State | IL
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Zip | 60521-3247
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Country | US
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Telephone | 630-325-6880
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Fax | 630-325-5975
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JAMES O ERTLE
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Credential | M.D.
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Telephone | 630-325-6880
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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 | 036-043180
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License Number State | IL
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