ILLINOIS DERMATOLOGY INSTITUTE, LLC (NPI# 1447613989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447613989 |
| Entity Type | Organization |
| Organization Name | ILLINOIS DERMATOLOGY INSTITUTE, LLC |
| Practice Address |
1550 N Northwest Hwy Suite 300 Park Ridge IL 60068-1411 |
| Practice Telephone | 8472981831 |
| Practice Fax Number | 8472981832 |
| Mailing Telephone | 8472981831 |
| Mailing Fax Number | 8472981832 |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-04-01 |
| Authorized Official Name | STEVEN MANDREA (PHYSICIAN) |
| Authorized Official Telephone | 8472981831 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
036111710 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036111710 | 05 | |
| IL | NPI | 1386663631 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891920898 | Illinois Dermatology Institute, LLC | Dermatology | 9711 Skokie Blvd, Suite J., Skokie, IL 60077-1384 | 2009-05-19 |
| Street Address |
1550 N NORTHWEST HWY SUITE 300 |
| City | PARK RIDGE |
| State | IL |
| Zip Code | 60068-1411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841270147 | Daniel Kniaz | Internal Medicine | 1550 N Northwest Hwy, Suite 303, Park Ridge, IL 60068-1411 | 2006-01-20 |
| 1104379973 | Jean-francois Tremblay | Colon & Rectal Surgery | 1550 N Northwest Hwy, Suite 107, Park Ridge, IL 60068-1411 | 2016-07-28 |
| 1578953972 | Brook Ernestine Medici | Physician Assistant | 1550 N Northwest Hwy, Suite 211, Park Ridge, IL 60068-1411 | 2015-01-23 |
| 1700153954 | Julia Koziol | Physician Assistant | 1550 N Northwest Hwy, Park Ridge, IL 60068-1411 | 2011-11-16 |
| 1659656049 | Kelly Ann Ali | Physician Assistant | 1550 N Northwest Hwy, Suite 220, Park Ridge, IL 60068-1411 | 2011-10-17 |
| 1164737110 | Kathleen Marie Harley | Physician Assistant | 1550 N Northwest Hwy, Suite 220, Park Ridge, IL 60068-1411 | 2010-08-15 |
| 1114249125 | Primary Care of Illinois, Sc | Internal Medicine | 1550 N Northwest Hwy, Suite 211, Park Ridge, IL 60068-1411 | 2010-02-17 |
| 1255591491 | Jordan Louis Goldstein | Orthopaedic Surgery | 1550 N Northwest Hwy, Suite 220, Park Ridge, IL 60068-1411 | 2008-06-11 |
| 1104048776 | Leslie Erin Bernstein | Dermatology | 1550 N Northwest Hwy, Suite 300, Park Ridge, IL 60068-1411 | 2007-05-03 |
| 1245362847 | Life Medical Sc | Internal Medicine | 1550 N Northwest Hwy, Suite 209, Park Ridge, IL 60068-1411 | 2007-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861010720 | Caitlin Marie Kompanowski | Dentist | 412 W. Talcott, Park Ridge, IL 60068 | 2020-07-08 |
| 1972142198 | Center for Authentic Living, Inc. | Counselor | 120 Main Street Suite 200, Park Ridge, IL 60068 | 2020-01-06 |
| 1306312152 | Maryann Almores Devilla | Physical Medicine & Rehabilitation | Sunrise Assisted Living, 1725 Ballard Road, Park Ridge, IL 60068 | 2018-10-19 |
| 1053808857 | Landon Ginsberg | Student in an Organized Health Care Education/Training Program | 1775 Ballard, Park Ridge, IL 60068 | 2018-04-17 |
| 1255828448 | Vera W Brink | Obstetrics & Gynecology | Parkside Professional Center, 1875 Dempster St., Ste. 330, Park Ridge, IL 60068 | 2018-04-13 |
| 1205367448 | Courtney Heim | Psychiatry & Neurology | 1875 W.dempster Street - Park Side Professional Center, Ste 470, Park Ridge, IL 60068 | 2017-03-21 |
| 1720521362 | Alexander Mylonas | Psychologist | 1400 Renaissance Dr Ste 401, Park Ridge, IL 60068 | 2016-11-30 |
| 1376090878 | Rebecca Rajasekhar | Audiologist | 1030 W. Higgins Rd., Audiology Room 6, Park Ridge, IL 60068 | 2016-09-01 |
| 1164818449 | Mohammad Taha Mustaf Taha Mustafa Sheikh | Student in an Organized Health Care Education/Training Program | 1550 North Northwest Highway Suite 107, L.m. Prasad, Md, Sc, Park Ridge, IL 60068 | 2015-04-13 |
| 1518397918 | Megan Roberts | Speech-Language Pathologist | 2240 Campus Dr., Evanston, IL 60068 | 2013-11-21 |
| Find all providers in zip 60068 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1295351062 | Sara M Gotheridge Md LLC | Clinic/Center | 630 Davis St Ste 301, Evanston, IL 60201-4480 | 2020-06-17 |
| 1407484645 | Macumber Medical Ltd | Clinic/Center | 3114 W Irving Park Rd Ste 1w, Chicago, IL 60618-3435 | 2020-04-01 |
| 1477181782 | Embassy Studios North | Clinic/Center | 6455 N Cicero Ave, Lincolnwood, IL 60712-3407 | 2020-03-31 |
| 1689226318 | Midway Spine and Joint Pain Physicians | Clinic/Center | 5720 S Pulaski Rd, Chicago, IL 60629-4435 | 2019-07-12 |
| 1215598891 | Vero Clinics | Clinic/Center | 1192 E Pershing Rd, Decatur, IL 62526-4753 | 2019-06-25 |
| 1497215933 | Activate Healthcare | Clinic/Center | 2010 N Damen Ave Unit F, Chicago, IL 60647-3286 | 2019-03-21 |
| 1033699467 | Healthpointe Medical Center Sc | Clinic/Center | 530 Fullerton Rd Ste B, Swansea, IL 62226-2970 | 2018-08-15 |
| 1740794882 | Highland Park Cvs, L.L.C. | Clinic/Center | 72 Airport Plz, Bethalto, IL 62010-1774 | 2017-11-28 |
| 1447764014 | Dr Courtney Drendel Inc | Clinic/Center | 515 Hamilton St # 100, Geneva, IL 60134-2138 | 2017-11-19 |
| 1699206599 | David M Conner M.d. | Clinic/Center | 9 Executive Woods Ct Ste 2, Swansea, IL 62226-2016 | 2017-03-22 |
| Find all providers with the same taxonomy | ||||
| City | PARK RIDGE |
| Zip Code | 60068 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.