SURGICAL SERVICES OF ILLINOIS, SC (NPI# 1932437290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932437290 |
| Entity Type | Organization |
| Organization Name | SURGICAL SERVICES OF ILLINOIS, SC |
| Other Organization Name | MD SKINCENTER |
| Practice Address |
1235 N Mulford Rd Ste. 205 Rockford IL 61107-3879 |
| Practice Telephone | 8154849900 |
| Practice Fax Number | 8154874949 |
| Mailing Telephone | 8154849900 |
| Mailing Fax Number | 8154874949 |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2016-07-13 |
| Authorized Official Name | DR. ANDREW I. JUN (PRESIDENT) |
| Authorized Official Telephone | 8154849900 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
Allopathic & Osteopathic Physicians | ||
| N | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
Allopathic & Osteopathic Physicians | ||
| N | 207YX0602X |
Otolaryngology Specialization: Otolaryngic Allergy |
Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE ID | IL2884 | 01 |
| Other Name | Type Code |
|---|---|
| MD SkinCenter | Doing Business As Name - Organization |
| Street Address |
1235 N MULFORD RD STE. 205 |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-3879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821091075 | Susan M Fowell | Ophthalmology | 1235 N Mulford Rd, Suite 100, Rockford, IL 61107-3879 | 2005-05-23 |
| 1164875852 | Bryn Maxine Byers Krause | Nurse Practitioner | 1235 N Mulford Rd, Suite 205, Rockford, IL 61107-3879 | 2016-07-18 |
| 1306211198 | Christine Lenox | Counselor | 1235 N Mulford Rd, Suite 200, Rockford, IL 61107-3879 | 2015-12-06 |
| 1962873919 | Renviva LLC | Clinic/Center | 1235 N Mulford Rd, Rockford, IL 61107-3879 | 2015-10-16 |
| 1578971487 | Northern Illinois Trauma Regional Orthopaedics, LLC | Orthopaedic Surgery | 1235 N Mulford Rd, Suite 103, Rockford, IL 61107-3879 | 2014-07-24 |
| 1598053571 | Stephanie Jo Drake | Physical Therapy Assistant | 1235 N Mulford Rd, Rockford, IL 61107-3879 | 2011-07-12 |
| 1154576221 | Tanya J. Munger | Registered Nurse | 1235 N Mulford Rd, Suite 222, Rockford, IL 61107-3879 | 2008-11-17 |
| 1376714600 | Laura Koch | Clinical Nurse Specialist | 1235 N Mulford Rd, Suite 200, Rockford, IL 61107-3879 | 2008-03-14 |
| 1669640504 | Todd D Alexander Md Sc | Neurological Surgery | 1235 N Mulford Rd, Suite 210, Rockford, IL 61107-3879 | 2008-02-13 |
| 1942483664 | Northern Illinois Retina Ltd | Ophthalmology | 1235 N Mulford Rd, Suite 100, Rockford, IL 61107-3879 | 2007-12-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| 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 |
|---|---|---|---|---|
| 1952505422 | Paul Revis Md Sc | Dermatology | 1055 Featherstone, Rockford, IL 61107 | 2007-06-11 |
| 1871576264 | Lakimerly Michelle Coates | Dermatology | 4338 Morsay Dr, Rockford, IL 61107-4877 | 2005-11-21 |
| 1477745255 | Melissa L Stenstrom | Dermatology | 1235 N Mulford Rd, Suite 205, Rockford, IL 61107-3879 | 2007-08-15 |
| 1225184948 | Edgebrook Dermatology P.C. | Dermatology | 1639 N Alpine Rd, Rockford, IL 61107-1449 | 2007-01-26 |
| 1710049234 | Edgebrook Dermatology, PC. | Dermatology | 1639 N Alpine Rd, Rockford, IL 61107-1449 | 2006-12-14 |
| 1922199967 | Maria I Al-basha | Dermatology | 1639 N Alpine Rd, Rockford, IL 61107-1449 | 2006-09-27 |
| 1518984293 | Paul Revis | Dermatology | 1055 Featherstone Rd, Rockford, IL 61107-5904 | 2006-07-17 |
| 1053391334 | Albert W. Hudson | Dermatology | 698 Featherstone Rd, Rockford, IL 61107-6303 | 2006-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275141251 | Derick Dermatology, LLC | Dermatology | 239 Remington Boulevard, Suite 225, Bolingbrook, IL 60440 | 2020-07-16 |
| 1063030252 | Vitalskin Medical Group Il Pllc | Dermatology | 1111 W Kenyon Rd, Urbana, IL 61801-1010 | 2020-07-14 |
| 1447873831 | Derick Dermatology, LLC | Dermatology | 5250 Old Orchard Rd Ste 110, Skokie, IL 60077-4461 | 2020-05-20 |
| 1346869393 | Julia Katsnelson Md Sc | Dermatology | 231 Olde Half Day Rd, Lincolnshire, IL 60069-2906 | 2020-04-10 |
| 1114551983 | Katherine Janezic | Dermatology | 7447 W Talcott Ave Ste 425, Chicago, IL 60631-3704 | 2020-03-02 |
| 1013559400 | Orsini Surgical Dermatology Sc | Dermatology | 1519 Legacy Cir, Naperville, IL 60563-3161 | 2019-10-17 |
| 1124675244 | Kiracofe Md Medical, LLC | Dermatology | 719 South Blvd # 2903, Oak Park, IL 60302-2903 | 2019-08-22 |
| 1366009664 | Derick Dermatology | Dermatology | 1900 Spring Rd Ste 210, Oak Brook, IL 60523-9063 | 2019-05-22 |
| 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 |
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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.