Provider Demographics
NPI:1063030252
Name:VITALSKIN MEDICAL GROUP IL PLLC
Entity type:Organization
Organization Name:VITALSKIN MEDICAL GROUP IL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER/CMO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:YOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-729-7650
Mailing Address - Street 1:1111 W KENYON RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1010
Mailing Address - Country:US
Mailing Address - Phone:217-729-7650
Mailing Address - Fax:
Practice Address - Street 1:917 REMINGTON RD
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4210
Practice Address - Country:US
Practice Address - Phone:217-205-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty