Conrad Petersen Dermatology SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CONRAD PETERSEN DERMATOLOGY SC

Practice address

2845 N Sheridan
Chicago, IL 60657

Phone

(773) 832-7443

Fax

(773) 295-4126

NPI assigned

Apr 2, 2019

Organization subpart

No

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

Authorized official

Name

Erin Petersen, MD

Title

Owner

Phone

(314) 518-0403

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1487116240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 N SHERIDAN",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-832-7443",
            "fax_number": "773-295-4126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 N SHERIDAN",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-832-7443",
            "fax_number": "773-295-4126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONRAD PETERSEN DERMATOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-518-0403",
        "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": []
}

• Craig Scott Conover, M.D.
• Conrad Care Inc
• Conrad Care Inc
• Conrad Care Incorporated
• Conrad May M.D. LTD
• Julie Conrad, MD
• Julie Marie Conrad, OTR/L
• Laurel M Conrad, M.A., CCC-SLP
• Patricia Conrad, MD
• Samantha B Conrad, MD

• 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 19, 2020; 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.