Provider Demographics
NPI:1386255123
Name:DERMATOLOGY ASSOCIATES LTD
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-444-8300
Mailing Address - Street 1:18425 W CREEK DR STE F
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6768
Mailing Address - Country:US
Mailing Address - Phone:708-444-8300
Mailing Address - Fax:
Practice Address - Street 1:13401 S RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1898
Practice Address - Country:US
Practice Address - Phone:708-444-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site