Provider Demographics
NPI:1871768846
Name:DERMATOLOGY AND DERMATOLOGIC SURGERY LTD
Entity type:Organization
Organization Name:DERMATOLOGY AND DERMATOLOGIC SURGERY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-302-3677
Mailing Address - Street 1:1001 HEALTH PARK DR STE 470
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5721
Mailing Address - Country:US
Mailing Address - Phone:630-302-3677
Mailing Address - Fax:630-302-3677
Practice Address - Street 1:1001 HEALTH PARK DR STE 470
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5721
Practice Address - Country:US
Practice Address - Phone:630-302-3677
Practice Address - Fax:630-302-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086A0122X207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG18909Medicare UPIN
IL205698Medicare PIN