Organization
DERMATOLOGY AND SKIN CANCER CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE SCHUPBACH MD (MD/PRACTICE OWNER)
(309) 533-7070
Entity
Organization
Contact information
Practice address
3302 GERIG DR STE 100, BLOOMINGTON, IL 61704-6343
(309) 533-7070
(855) 710-6552
Mailing address
3302 GERIG DR STE 100, BLOOMINGTON, IL 61704-6343
(309) 533-7070
(855) 710-6552
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Enumeration date
10/10/2023
Last updated
12/17/2024
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