Radiant Dermatology, LTD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

RADIANT DERMATOLOGY, LTD

Practice address

1740 Mediterranean Dr Ste 102
Sycamore, IL 60178-3191

Phone

(815) 981-4990

Fax

(815) 517-0064

NPI assigned

Nov 6, 2014

Organization subpart

No

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

Authorized official

Name

Amanda Friedrichs

Title

Owner/Ceo

Phone

(815) 981-4990

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1871999680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 MEDITERRANEAN DR STE 102",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783191",
            "telephone_number": "815-981-4990",
            "fax_number": "815-517-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 MEDITERRANEAN DR STE 102",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783191",
            "telephone_number": "815-981-4990",
            "fax_number": "815-517-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT DERMATOLOGY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "FRIEDRICHS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "815-981-4990"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Sycamore, IL
• Providers in Sycamore, 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 23, 2015; 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.