Advanced Dermatology,LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ADVANCED DERMATOLOGY,LLC

Practice address

275 Parkway Dr
Suite 521
Lincolnshire, IL 60069-4341

Phone

(847) 459-6400

Fax

(847) 459-4610

NPI assigned

May 11, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Forman Taub, M.D.NPI 1215967765

Title

Medical Director

Phone

(847) 459-6400

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Advanced Dermatology Clinic, Inc.

  • Dermatology Physician
  • Freeport, IL
  • NPI 1881167278
  NPPES parent name

Practitioners 1

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.

• Amy F Taub, M.D.

  • Dermatology Physician
  • Lincolnshire, IL
  • NPI 1215967765
  Authorized official Same address or phone

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528273505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 PARKWAY DR",
            "address_2": "SUITE 521",
            "city": "LINCOLNSHIRE",
            "state": "IL",
            "postal_code": "600694341",
            "telephone_number": "847-459-6400",
            "fax_number": "847-459-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 PARKWAY DR",
            "address_2": "SUITE 521",
            "city": "LINCOLNSHIRE",
            "state": "IL",
            "postal_code": "600694341",
            "telephone_number": "847-459-6400",
            "fax_number": "847-459-4610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAUB",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "FORMAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "847-459-6400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lincolnshire, IL
• Providers in Lincolnshire, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.