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General NPI Number Information
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NPI Number | 1922122662
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Entity Type | Organization
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Legal Business Name | SEPTON DERMATOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 755 S MILWAUKEE AVE STE 224
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3266
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Country | US
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Telephone | 847-367-5575
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Fax | 847-367-5579
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Provider Business Mailing Address
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Address Line | 755 S MILWAUKEE AVE STE 224
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3266
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Country | US
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Telephone | 847-367-5575
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Fax | 847-367-5579
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT M SEPTON
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Credential | M.D.
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Telephone | 847-367-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036043331
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License Number State | IL
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