Edgebrook Dermatology, PC.
Dermatology in Rockford, IL. Organization (NPI-2).
NPI number1710049234
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1710049234
- Entity type
- Organization (NPI-2)
- Legal business name
- Edgebrook Dermatology, PC.
- Organization subpart
- No
- Enumeration date
- Dec 14, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
Practice location
1639 N Alpine RdRockford, IL 61107-1449
Phone 815-229-9333
Mailing address
Po Box 1686Rockford, IL 61110-0186
Authorized official
Maria Albasha
President
8152299333
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