Organization
ASSOCIATED DERMATOLOGISTS LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY M. NEWELL M.D. (PRESIDENT)
(217) 726-6429
Entity
Organization
Contact information
Practice address
2951 MONTVALE DR, SUITE B, SPRINGFIELD, IL 62704-5341
(217) 726-6429
(217) 726-6786
Mailing address
2951 MONTVALE DR, SUITE B, SPRINGFIELD, IL 62704-5341
(217) 726-6429
(217) 726-6786
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUECROSSBLUE SHIELD
GROUP PROVIDER #
IL
Enumeration date
01/31/2007
Last updated
02/07/2008
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