AESTHETIC DERMATOLOGY (NPI# 1831125152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831125152 |
| Entity Type | Organization |
| Organization Name | AESTHETIC DERMATOLOGY |
| Practice Address |
2551 N Clark St Suite #201 Chicago IL 60614-1798 |
| Practice Telephone | 7738835300 |
| Practice Fax Number | 7738831807 |
| Mailing Telephone | 7738835300 |
| Mailing Fax Number | 7738831807 |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JONITH Y BREADON (OWNER) |
| Authorized Official Telephone | 7738835300 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164748117 | Aesthetic Dermatology | Dermatology | 300 Taylor Rd, Suite 800, Montgomery, AL 36117-3521 | 2010-04-15 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Aesthetic Dermatology & Surgery Clinique P.C. | 3811 Gaskins Rd, Richmond, Virginia 23233 |
| New York State Corporations | AESTHETIC DERMATOLOGY LLC | 800 Woodbury Road, Woodbury, Ny 11791 |
| Street Address |
2551 N CLARK ST SUITE #201 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60614-1798 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154304848 | Aaron Thomas Donnell | Allergy & Immunology | 2551 N Clark St, Suite 100, Chicago, IL 60614-1798 | 2005-11-28 |
| 1447858683 | Jazmine Hudson | Durable Medical Equipment & Medical Supplies | 2551 N Clark St, Chicago, IL 60614-1798 | 2020-10-10 |
| 1306245782 | Neel French Md, Sc | Internal Medicine | 2551 N Clark St, Suite 303, Chicago, IL 60614-1798 | 2014-08-21 |
| 1629408646 | Kathryn Herrera | Acupuncturist | 2551 N Clark St, Suite 605, Chicago, IL 60614-1798 | 2013-11-13 |
| 1619304433 | Nicholas Skasa | Counselor | 2551 N Clark St, Suite 800, Chicago, IL 60614-1798 | 2013-10-11 |
| 1730526229 | Gabriel Sim | Dentist | 2551 N Clark St, Suite 404, Chicago, IL 60614-1798 | 2013-05-24 |
| 1053755801 | Chicago Dental Partners, LLC | Public Health or Welfare | 2551 N Clark St, Suite 600, Chicago, IL 60614-1798 | 2013-04-23 |
| 1487991337 | Urban Brain and Body, LLC | Counselor | 2551 N Clark St, 8th Floor, Chicago, IL 60614-1798 | 2013-01-12 |
| 1023352382 | Kelly Jane Martin | Counselor | 2551 N Clark St, Suite 800, Chicago, IL 60614-1798 | 2012-11-26 |
| 1720364953 | Noah Ryan Goss | Physician Assistant | 2551 N Clark St, 203, Chicago, IL 60614-1798 | 2011-11-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487266516 | Taylor Connington | Pharmacist | 843 W Armitage Ave, Chicago, IL 60614 | 2020-08-19 |
| 1356975692 | Amarilis Diaz | Social Worker | Terry Hefter Associates, LLC, 1731 N. Marcey Suite 535, Chicago, IL 60614 | 2020-02-25 |
| 1457902975 | Michele Waggoner | Physical Therapist | 2515 N. Clark St, Chicago, IL 60614 | 2019-09-25 |
| 1669031936 | Justin Pomeroy | Acupuncturist | 1350 W. Schubert Ave., Chicago, IL 60614 | 2019-06-11 |
| 1801451547 | Amanda Harris | Counselor | 2451 N Lincoln Ave # 206, Chicago, IL 60614 | 2019-05-08 |
| 1780164574 | Danielle Trokey | Psychiatry & Neurology | 2515 N Clark St Ste 801, Chicago, IL 60614 | 2018-08-21 |
| 1841707353 | Madison Counseling Solutions LLC | Social Worker | 2502 N. Clark St., Chicago, IL 60614 | 2018-01-05 |
| 1386154011 | Allison Cooper Boyan | Occupational Therapist | 1640 N. Wells St., Unit 103, Chicago, IL 60614 | 2017-10-09 |
| 1245759653 | Eileen Davidson Siegel | Physician Assistant | 2073 N. Clybourn Ave., Chicago, IL 60614 | 2017-09-18 |
| 1447779814 | Elizabeth Hobart | Psychologist | 1800 W. Diversey Pkwy, Unit H, Chicago, IL 60614 | 2017-09-16 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114551983 | Katherine Janezic | Dermatology | 7447 W Talcott Ave Ste 425, Chicago, IL 60631-3704 | 2020-03-02 |
| 1487116240 | Conrad Petersen Dermatology Sc | Dermatology | 2845 N Sheridan, Chicago, IL 60657 | 2019-04-02 |
| 1891257853 | Maria Estela Martinez Escala | Dermatology | 5841 S Maryland Ave Ste Mc5067, Chicago, IL 60637-1443 | 2019-04-01 |
| 1275013450 | Advanced Dermatology and Aesthetic Medicine | Dermatology | 850 S Wabash Ave Ste 200, Chicago, IL 60605-3642 | 2018-08-17 |
| 1346784543 | Dermio, LLC | Dermatology | 3023 N Clark St, Suite 861, Chicago, IL 60657-5200 | 2016-12-07 |
| 1366823544 | Oyinade Aderibigbe | Dermatology | 111 W Washington St Ste 1801, Chicago, IL 60602-3430 | 2015-06-14 |
| 1073909032 | Julia Dai | Dermatology | 5758 S Maryland Ave Fl 3, Chicago, IL 60637 | 2015-04-07 |
| 1437544582 | Nicholas Blickenstaff | Dermatology | 30 N Michigan Ave Ste 1429, Chicago, IL 60602-3698 | 2015-04-04 |
| 1801285929 | Medical Dermatology Associates of Chicago, Ltd | Dermatology | 363 W Erie St, Suite 350, Chicago, IL 60654-6903 | 2015-01-13 |
| 1366857286 | Noor Tazudeen | Dermatology | 4700 N Marine Dr Ste 220, Chicago, IL 60640-7972 | 2014-06-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.