Summit Dermatology and Aesthetic Surgery LTD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036125561 Issued in IL

Legal business name

SUMMIT DERMATOLOGY AND AESTHETIC SURGERY LTD

Practice address

1S210 Summit Ave
Oakbrook Terrace, IL 60181-3933

Phone

(630) 627-3376

NPI assigned

Sep 28, 2010

Organization subpart

No

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

Authorized official

Name

Rania Agha, M.DNPI 1366601312

Title

President

Phone

(630) 282-6004

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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

• Rania Agha, M.D.

  • Dermatology Physician
  • Oakbrook Terrace, IL
  • NPI 1366601312
  Medicare reassignment Care Compare group NPD Authorized official
• Yuliya Olegovna Gofman, PA-C

  • Physician Assistant
  • Arlington Heights, IL
  • NPI 1821839291
  Medicare reassignment Care Compare group
• Ibrahim Majzoub, M.D.

  • Pulmonary Disease Physician
  • Chicago, IL
  • NPI 1366537409
  NPD (past)

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1376852137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 HEWITT DR",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600166041",
            "telephone_number": "847-298-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1S210 SUMMIT AVE",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813933",
            "telephone_number": "630-627-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DERMATOLOGY AND AESTHETIC SURGERY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-28",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "AGHA",
        "authorized_official_first_name": "RANIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-282-6004",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036125561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Joseph Sullivan, MD
• Sana Sultana, DC
• Summit Center for Health, LLC
• Summit Center for Health, LTD
• Summit Center for Surgery LLC
• Summit Surgicare
• Superior Interventions,LLC
• Surgical Center of Oakbrook Terrace
• Adeeb Ullah Syed, DO
• T.a. Global Networks Inc

• Dermatology Physician in Oakbrook Terrace, IL
• Providers in Oakbrook Terrace, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.