Illinois Skin Center LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ILLINOIS SKIN CENTER LLC

Practice address

2202 N Halsted St Ste 1
Chicago, IL 60614-3625

Phone

(312) 600-5826

Fax

(872) 260-5008

NPI assigned

Apr 10, 2020

Last updated

Feb 27, 2025By 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

Dr. David Othman, MDNPI 1760741938

Title

President and Ceo

Phone

(312) 600-5826

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00156

Practitioners 3

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.

• David Zachary Othman, M.D., M.H.S.A

  • Procedural Dermatology Physician
  • Chicago, IL
  • NPI 1760741938
  Medicare reassignment NPD Authorized official
• Julia Kocemba, PA-C

  • Physician Assistant
  • Arlington Heights, IL
  • NPI 1851865257
  NPD (past)
• Solomiya Grushchak, MD

  • Dermatology Physician
  • San Diego, CA
  • NPI 1588168108
  NPD (past)

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

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1588283402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 N HALSTED ST STE 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143625",
            "telephone_number": "312-600-5826",
            "fax_number": "872-260-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 N HALSTED ST STE 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143625",
            "telephone_number": "312-600-5826",
            "fax_number": "872-260-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS SKIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-10",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "OTHMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "312-600-5826",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Illinois Physicians Alliance, LLC
• Illinois Physicians Network, LLC
• Illinois Physicians Wellness Group LLC
• Illinois Professional Medical Services PLLC
• Illinois Senior Services Inc
• Illinois Spine and Joint Center LTD.
• Illinois Surgeon Association LLC
• Illinois Therapeutic and Nursing Services, LLC
• Illinois Therapeutic Services, LLC
• Illinois Veterans Home at Chicago

• 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 Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.