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Contact Information

CRYSTAL LAKE DERMATOLOGY SC
278 MEMORIAL DR
CRYSTAL LAKE, IL60014
 Phone: 815-477-9867
 Fax: 815-477-9868
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for CRYSTAL LAKE DERMATOLOGY SC · (Female)

NPI # 1982777231
Status Active
Credentials
Entity Individual
Enumeration date 11/16/2006
Last updated 07/29/2013 - About 13 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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