Provider Demographics
NPI:1396484119
Name:ON THE SPOT DERMATOLOGY PLLC
Entity type:Organization
Organization Name:ON THE SPOT DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPP
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, FPA
Authorized Official - Phone:847-208-1016
Mailing Address - Street 1:2175 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6072
Mailing Address - Country:US
Mailing Address - Phone:847-208-1016
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE STE 409
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5804
Practice Address - Country:US
Practice Address - Phone:847-208-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty