NPIMap

Organization Active NPI

Center for Dermatology and Skin Cancer LTD

  • MOHS-Micrographic Surgery Physician
  • Lombard, IL
National Provider Identifier
1255358289
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
CENTER FOR DERMATOLOGY AND SKIN CANCER LTD
Practice address
2500 S Highland Ave
Suite 200
Lombard, IL 60148-5363
Phone
(630) 964-2000
Fax
(630) 964-6378
NPI assigned
Jul 16, 2006
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Mr. Robert Victor Kolbusz, M.DNPI 1669403457
Title
Owner
Phone
(630) 964-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X NU Primary

Addresses

Primary practice location

2500 S Highland Ave
Suite 200
Lombard, IL 60148-5363

Mailing address

2500 S Highland Ave
Suite 200
Lombard, IL 60148-5363
Phone (630) 964-2000

Other identifiers 1

IdentifierTypeStateIssuer
02207012OtherILBCBS

National Provider Directory

National Provider Directory

Locations

3825 Highland Ave
Ste 4D
Downers Grove, IL 60515
Phone (630) 964-2000

2500 S Highland Ave
Ste 200
Lombard, IL 60148
Phone (630) 964-2000

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1255358289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 S HIGHLAND AVE",
            "address_2": "SUITE 200",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485363",
            "telephone_number": "630-964-2000",
            "fax_number": "630-964-6378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S HIGHLAND AVE",
            "address_2": "SUITE 200",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485363",
            "telephone_number": "630-964-2000",
            "fax_number": "630-964-6378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DERMATOLOGY AND SKIN CANCER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "KOLBUSZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-964-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02207012",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lombard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.