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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

NPI # 1982777231
LBN Legal business name CRYSTAL LAKE DERMATOLOGY SC
Authorized official JAMIE CHIN - (PHYSICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 11/16/2006
Last updated 07/29/2013 - About 13 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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