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General NPI Number Information
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NPI Number | 1780795856
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF LAGRANGE SC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 5201 WILLOW SPRINGS RD SUITE #430
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City | LA GRANGE HIGHLANDS
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State | IL
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Zip | 60525-6537
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Country | US
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Telephone | 708-482-3213
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Fax | 708-482-3230
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Provider Business Mailing Address
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Address Line | 5201 WILLOW SPRINGS RD SUITE #430
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City | LA GRANGE HIGHLANDS
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State | IL
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Zip | 60525-6537
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Country | US
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Telephone | 708-482-3213
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Fax | 708-482-3230
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. SHELLEY J. HALPER
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Credential | M.D.
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Telephone | 708-482-3213
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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 | 042-616911
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License Number State | IL
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