Dermatology Associates of Hinsdale, S.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036-043180 Issued in IL

Legal business name

DERMATOLOGY ASSOCIATES OF HINSDALE, S.C.

Practice address

333 Chestnut St
Suite 202
Hinsdale, IL 60521-3247

Phone

(630) 325-6880

Fax

(630) 325-5975

NPI assigned

Apr 6, 2007

Last updated

Sep 16, 2008By 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

James O Ertle, M.D.

Title

Physician

Phone

(630) 325-6880

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1679695829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 CHESTNUT ST",
            "address_2": "SUITE 202",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213247",
            "telephone_number": "630-325-6880",
            "fax_number": "630-325-5975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 CHESTNUT ST",
            "address_2": "SUITE 202",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213247",
            "telephone_number": "630-325-6880",
            "fax_number": "630-325-5975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF HINSDALE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "ERTLE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "630-325-6880",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-043180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "1679695829",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP",
            "identifier": "1679695829",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Hinsdale, IL
• Providers in Hinsdale, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; 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.