MEDICARE: DERMACARE PLUS, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.291589	IL
2	207R00000X	Internal Medicine Physician	036112407	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2232893	OTHER	IL	BCBS OF ILLINOIS

General Provider Information

NPI Number	:	1487722831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMACARE PLUS, LTD

Provider Business Mailing Address
First Line	:	4256 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE 240
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1300
Country	:	US
Telephone Number	:	847-253-0807
Fax Number	:	847-253-0837

Provider Business Practice Location Address
First Line	:	4256 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE 240
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1300
Country	:	US
Telephone Number	:	847-253-0807
Fax Number	:	847-253-0837

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BELLA J SOLO
Credential	:
Telephone Number	:	847-253-0807

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	03/31/2015

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