NPI 1770966459

Integrated Dermatology of Calumet City LLC

Organisation Dermatology Physician Calumet City, IL

Practice location

Address: 19 River Oaks Dr, Calumet City, IL 60409-5802
Phone: (708) 862-1290
Mailing address: 4700 Exchange CT STE 110, Boca Raton, FL 33431-4450

Authorised official

Name: Jeffrey Queen
Title: Manager
Phone: (561) 314-2000

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X

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Registry record

NPI: 1770966459
Entity type: Organization
NPI issued: 30 Jun 2015
Record last updated: 15 Jan 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.