Provider Demographics
NPI:1023067964
Name:AESTHETIC AND CLINICAL DERMATOLOGY ASSOCIATES, LTD
Entity type:Organization
Organization Name:AESTHETIC AND CLINICAL DERMATOLOGY ASSOCIATES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZAHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-455-1756
Mailing Address - Street 1:908 N ELM ST
Mailing Address - Street 2:STE 300
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3625
Mailing Address - Country:US
Mailing Address - Phone:630-455-1756
Mailing Address - Fax:630-455-1759
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:SUITE 309
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-455-1756
Practice Address - Fax:630-455-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007910207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL545250Medicare ID - Type Unspecified
IL02208147OtherBCBSIL PROVIDER NUMBER