Organization Active NPI

Dermatology and Aesthetics of Wicker Park, PLLC

  • Dermatology Physician
  • Chicago, IL
National Provider Identifier
1386777241
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY AND AESTHETICS OF WICKER PARK, PLLC
Practice address
1765 N Elston Ave
Suite 110
Chicago, IL 60642-1501
Phone
(773) 276-1100
Fax
(773) 276-1102
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Authorized official

Name
Neha Robinson, MD
Title
Owner/ Physician
Phone
(773) 276-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1765 N Elston Ave
Suite 110
Chicago, IL 60642-1501

Mailing address

1765 N Elston Ave
Suite 110
Chicago, IL 60642-1501
Phone (773) 276-1100

Other names 1

  • Dermatology and Aesthetics of Wicker Park, LLC Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1066591Dermatology & Aesthetics, Wicker Park1765 N Elston Ave, Ste 110, Chicago, IL 60642Provider-performed microscopyMay 7, 2027

National Provider Directory

National Provider Directory

Locations

1733 N Harlem Ave
Chicago, IL 60707
Phone (773) 237-6666

1455 N Milwaukee Ave
#2
Chicago, IL 60622
Phone (773) 276-1100

541 N Fairbanks Ct
Ste 1450
Chicago, IL 60611

680 N Lake Shore Dr
#D
Chicago, IL 60611

1765 N Elston Ave
Chicago, IL 60642
Phone (312) 399-0370

1765 N Elston Ave
Ste 110
Chicago, IL 60642
Phone (773) 276-1100

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1386777241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 N ELSTON AVE",
            "address_2": "SUITE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606421501",
            "telephone_number": "773-276-1100",
            "fax_number": "773-276-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 N ELSTON AVE",
            "address_2": "SUITE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606421501",
            "telephone_number": "773-276-1100",
            "fax_number": "773-276-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND AESTHETICS OF WICKER PARK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "NEHA",
        "authorized_official_title_or_position": "OWNER/  PHYSICIAN",
        "authorized_official_telephone_number": "773-276-1100",
        "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": [
        {
            "organization_name": "Dermatology and Aesthetics of Wicker Park, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.