MEDICARE: SKIN CARE SERVICES, LLC

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	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1497709489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIN CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1901 BUTTERFIELD RD
Second Line	:	SUITE 220
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-7915
Country	:	US
Telephone Number	:	630-725-2700
Fax Number	:	630-725-2783

Provider Business Practice Location Address
First Line	:	5550 GLADES RD
Second Line	:	SUITE 210
City	:	BOCA RATON
State	:	FL
Zip	:	33431-7205
Country	:	US
Telephone Number	:	561-750-2130
Fax Number	:	561-367-6170

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER PEREZ
Credential	:	MD
Telephone Number	:	561-472-4605

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	06/22/2009

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