Provider Demographics
NPI:1487722831
Name:DERMACARE PLUS, LTD
Entity type:Organization
Organization Name:DERMACARE PLUS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-253-0807
Mailing Address - Street 1:4256 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1300
Mailing Address - Country:US
Mailing Address - Phone:847-253-0807
Mailing Address - Fax:847-253-0837
Practice Address - Street 1:4256 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1300
Practice Address - Country:US
Practice Address - Phone:847-253-0807
Practice Address - Fax:847-253-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291589183500000X
IL036112407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232893OtherBCBS OF ILLINOIS