Village Dermatology, SC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

042619944 Issued in IL

Legal business name

VILLAGE DERMATOLOGY, SC

Practice address

401 Linden Ave
Wilmette, IL 60091-2844

Phone

(847) 920-9177

Fax

(847) 920-9188

NPI assigned

Oct 17, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Cecelia H Ricketts, MD

Title

Owner

Phone

(847) 920-9177

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1518210327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 LINDEN AVE",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912844",
            "telephone_number": "847-920-9177",
            "fax_number": "847-920-9188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 LINDEN AVE",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912844",
            "telephone_number": "847-920-9177",
            "fax_number": "847-920-9188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE DERMATOLOGY, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "RICKETTS",
        "authorized_official_first_name": "CECELIA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-920-9177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "042619944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pieter A Van Heule, D.C.
• Allison Field Vanhorn, ATC
• Axel Vargas, M.D.
• Lisa Verderber
• Victoria Y. Hass PHD, PLLC
• Village of Wilmette
• Village of Wilmette
• Kannan Vinaitheerthan, LCSW
• Viridian Medical Group, PLLC
• Vital Balance Psychiatry PLLC

• Clinic/Center in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.