Laser and Cosmetic Dermatology

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036087208 Issued in IL

Legal business name

LASER AND COSMETIC DERMATOLOGY

Practice address

10510 S Roberts Rd
Palos Hills, IL 60465-1934

Phone

(708) 974-4270

Fax

(630) 706-4446

NPI assigned

Mar 15, 2011

Organization subpart

No

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

Authorized official

Name

Jawdat Abboud, MD

Title

President

Phone

(708) 974-4270

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1548569643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10510 S ROBERTS RD",
            "city": "PALOS HILLS",
            "state": "IL",
            "postal_code": "604651934",
            "telephone_number": "708-974-4270",
            "fax_number": "630-706-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10510 S ROBERTS RD",
            "city": "PALOS HILLS",
            "state": "IL",
            "postal_code": "604651934",
            "telephone_number": "708-974-4270",
            "fax_number": "630-706-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER AND COSMETIC DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "ABBOUD",
        "authorized_official_first_name": "JAWDAT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-974-4270",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036087208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Srilaya Kudaravalli
• Mark Kuklewicz, PT
• Katrina Kurtz, LCPC, ATR
• Kwikrx LLC
• David P Lachajewski, DDS
• Andrew John Latoszewski, LCSW
• Amber Lawrence, PA
• Anita Lewis, MHP
• Kevin Gerardo Lindsay-Rivera, MD
• Kiera Marie Mackin

• Primary Care Clinic/Center in Palos Hills, IL
• Providers in Palos Hills, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; 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.