Premier Dermatology LTD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PREMIER DERMATOLOGY LTD

Practice address

2051 Plainfield Rd
Crest Hill, IL 60403-1865

Phone

(815) 741-4343

Fax

(815) 741-8660

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Matthew R Kelleher, M.D.

Title

Medical Director

Phone

(815) 741-4343

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Todd T Davis, MD

  • Dermatology Physician
  • Elmhurst, IL
  • NPI 1629063169
  NPD (past)
• Brandon Lynn Miner, D.O

  • MOHS-Micrographic Surgery Physician
  • Idaho Falls, ID
  • NPI 1528279189

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1922053370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 PLAINFIELD RD",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604031865",
            "telephone_number": "815-741-4343",
            "fax_number": "815-741-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 PLAINFIELD RD",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604031865",
            "telephone_number": "815-741-4343",
            "fax_number": "815-741-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DERMATOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "KELLEHER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "815-741-4343",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL PROVIDER #",
            "identifier": "009900257",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Allen Pavlich, LCPC
• Cristina Amelia Perez Gomez, MD
• Rafael A Perez-Guerra, MD
• Kenneth Thomas Perona, D.C.
• Jennifer J Planing, LCPC
• Premiumhealthcare PC
• Alexandria Prisco, LCPC, ATR
• Priziva Optical, LTD.
• Kimberly Prosser, LPC
• Kayla Purdum, DC

• Dermatology Physician in Crest Hill, IL
• Providers in Crest Hill, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; 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.