Organization
DERMATOLOGY & SKIN SURGERY ASSOCIATES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA M STOCKTON MD (PRESIDENT)
(708) 478-3530
Entity
Organization
Contact information
Practice address
19639 S LAGRANGE RD, MOKENA, IL 60448
(708) 478-3530
(708) 478-3537
Mailing address
19639 S LAGRANGE RD, MOKENA, IL 60448
(708) 478-3530
(708) 478-3537
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036073727
IL
207N00000X
Dermatology Physician
036109235
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073727
—
IL
Enumeration date
08/31/2006
Last updated
05/18/2011
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