# VILLAGE DERMATOLOGY, SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518210327
- **Authorized official:** DR. CECELIA H RICKETTS MD (OWNER)
- **Authorized official phone:** (847) 920-9177

## Contact information

- **Practice address:** 401 LINDEN AVE, WILMETTE, IL 60091-2844
- **Practice address phone:** (847) 920-9177
- **Practice address fax:** (847) 920-9188
- **Mailing address:** 401 LINDEN AVE, WILMETTE, IL 60091-2844
- **Mailing address phone:** (847) 920-9177
- **Mailing address fax:** (847) 920-9188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 042619944 | IL | Yes |

## Other

- **Enumeration date:** 10/17/2012
- **Last updated:** 10/17/2012