Provider Demographics
NPI:1932271210
Name:DERMATOLOGY PHYSICIANS & SURGEONS, LTD
Entity Type:Organization
Organization Name:DERMATOLOGY PHYSICIANS & SURGEONS, LTD
Other - Org Name:VAN DAM DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VAN DAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-382-5111
Mailing Address - Street 1:738 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2640
Mailing Address - Country:US
Mailing Address - Phone:847-382-5111
Mailing Address - Fax:847-382-8993
Practice Address - Street 1:738 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2640
Practice Address - Country:US
Practice Address - Phone:847-382-5111
Practice Address - Fax:847-382-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
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
IL617640Medicare ID - Type UnspecifiedCRYSTAL LAKE OFFICE
IL617641Medicare ID - Type UnspecifiedBARRINGTON OFFICE