Asmsc-Morton Grove Il SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ASMSC-MORTON GROVE IL SC

Practice address

9300 Waukegan Rd
Morton Grove, IL 60053-1312

Phone

(847) 299-1044

Fax

(847) 299-0425

NPI assigned

Mar 16, 2021

Last updated

Mar 16, 2021By 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

Clarence W Brown Jr., M.D., J.D.

Title

Owner/Ceo/President

Phone

(269) 985-0021

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1679158174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853203",
            "telephone_number": "269-985-0021",
            "fax_number": "269-281-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 WAUKEGAN RD",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600531312",
            "telephone_number": "847-299-1044",
            "fax_number": "847-299-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASMSC-MORTON GROVE IL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-985-0021",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D., J.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Morton Grove, IL
• Providers in Morton Grove, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.