NPIMap

Organization Active NPI

Academic & Clinical Associates in Dermatology LTD

  • Dermatology Physician
  • Oak Park, IL
National Provider Identifier
1497972418
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036035438 Issued in IL
Legal business name
ACADEMIC & CLINICAL ASSOCIATES IN DERMATOLOGY LTD
Practice address
7047 North Ave
Oak Park, IL 60302-1015
Phone
(708) 383-0300
NPI assigned
Apr 19, 2007
Last updated
Nov 12, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

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

Authorized official

Name
Moria Bernstein
Title
Attorney
Phone
(708) 715-6848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 036035438 IL Primary

Addresses

Primary practice location

7047 North Ave
Oak Park, IL 60302-1015

Mailing address

7047 North Ave
Oak Park, IL 60302-1015
Phone (708) 383-0300

Other identifiers 1

IdentifierTypeStateIssuer
01615155OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1497972418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7047 NORTH AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021015",
            "telephone_number": "708-383-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7047 NORTH AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021015",
            "telephone_number": "708-383-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC & CLINICAL ASSOCIATES IN DERMATOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "BERNSTEIN",
        "authorized_official_first_name": "MORIA",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "708-715-6848"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036035438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01615155",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.