Provider Demographics
NPI:1962897629
Name:DERMATOLOGY ASSOCIATES OF OAKBROOK TERRACE SC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF OAKBROOK TERRACE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-953-1190
Mailing Address - Street 1:1 SOUTH 224 SUMMIT AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-953-1190
Mailing Address - Fax:630-953-1102
Practice Address - Street 1:1 SOUTH 224 SUMMIT AVE. SUITE 106
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-953-1190
Practice Address - Fax:630-953-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty