Provider Demographics
NPI:1669495073
Name:QUIMBY DERMATOLOGY, LTD.
Entity type:Organization
Organization Name:QUIMBY DERMATOLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUIMBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-451-0214
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3592
Mailing Address - Country:US
Mailing Address - Phone:309-451-0214
Mailing Address - Fax:309-451-8210
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE 230B
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3592
Practice Address - Country:US
Practice Address - Phone:309-451-0214
Practice Address - Fax:309-451-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5721563OtherBLUE CROSS
ILC51137Medicare UPIN
IL5721563OtherBLUE CROSS