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General NPI Number Information
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NPI Number | 1811060312
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Entity Type | Organization
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Legal Business Name | ILLINOIS SKIN
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1975 LIN LOR LN #205
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City | ELGIN
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State | IL
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Zip | 60123-4902
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Country | US
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Telephone | 847-742-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1600
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-789-2550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARI ANN UNGARETTI
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Credential | DO
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Telephone | 847-742-1000
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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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