Dermatology Physicians SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY PHYSICIANS SC

Practice address

680 N Lake Shore Dr Ste 1208
Chicago, IL 60611-8701

Phone

(312) 483-4397

NPI assigned

Feb 13, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Motunrayo Adisa, MDNPI 1326229121

Title

Owner

Phone

(773) 875-2029

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Motunrayo Adisa, M.D

  • Dermatology Physician
  • Kenilworth, IL
  • NPI 1326229121
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1063978138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 N WELLS ST APT 1003",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543958",
            "telephone_number": "773-875-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 N LAKE SHORE DR STE 1208",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606118701",
            "telephone_number": "312-483-4397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY PHYSICIANS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-13",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "ADISA",
        "authorized_official_first_name": "MOTUNRAYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-875-2029",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gordon Harris Derman, M. D.
• Yael Emily Derman, CPNP-AC
• Dermatology and Aesthetics of Wicker Park, PLLC
• Dermatology Consultants LTD
• Dermatology Physicians Group, LLC
• Dermatology Specialist, LTD
• Dermatology-Chicago S C
• Shannon B Dermer, PH.D.
• Patrick Artin Dermesropian, D.D.S.
• Dermio, LLC

• Dermatology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.