Provider Demographics
NPI:1861571051
Name:ADVANCED CLINICAL & SURGICAL DERMATOLOGY
Entity type:Organization
Organization Name:ADVANCED CLINICAL & SURGICAL DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JANIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-236-4315
Mailing Address - Street 1:PO BOX 9504
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-0504
Mailing Address - Country:US
Mailing Address - Phone:630-236-4315
Mailing Address - Fax:630-236-4316
Practice Address - Street 1:1012 95TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5041
Practice Address - Country:US
Practice Address - Phone:630-236-4315
Practice Address - Fax:630-236-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL427770Medicare ID - Type Unspecified
ILE67703Medicare UPIN