Rockford Dermatology Sc
Dermatology in Rockford, IL. Organization (NPI-2).
NPI number1487751335
StatusActive
Last updated in NPPESFeb 19, 2018
Details
- NPI
- 1487751335
- Entity type
- Organization (NPI-2)
- Legal business name
- Rockford Dermatology Sc
- Organization subpart
- No
- Enumeration date
- Sep 20, 2006
- Last updated
- Feb 19, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | 042617821 | IL | Yes |
| 207NS0135X | Dermatology, Procedural Dermatology | 042617821 | IL |
Practice location
4338 Morsay DrRockford, IL 61107-4877
Phone 815-399-6400 · Fax 815-399-4424
Mailing address
4338 Morsay DrRockford, IL 61107-4877
Phone 815-399-6400 · Fax 815-399-4424
Authorized official
Lakimerly Michelle Coates
President
8153996400
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