Provider Demographics
NPI:1588359293
Name:COMPLETE DERMATOLOGY LLC
Entity type:Organization
Organization Name:COMPLETE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ILKOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-354-6931
Mailing Address - Street 1:21550 BISCAYNE BLVD STE 131
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1258
Mailing Address - Country:US
Mailing Address - Phone:305-814-3376
Mailing Address - Fax:305-939-5928
Practice Address - Street 1:21550 BISCAYNE BLVD STE 131
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1258
Practice Address - Country:US
Practice Address - Phone:305-814-3376
Practice Address - Fax:305-939-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty