Organization
SOUTHERN ILLINOIS DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TED G VAN ACKER D. O. (PRESIDENT)
(618) 942-3344
Entity
Organization
Contact information
Practice address
220 N PARK AVE, SUITE 2, HERRIN, IL 62948-3150
(618) 942-3344
(618) 942-5045
Mailing address
220 N PARK AVE, SUITE 2, HERRIN, IL 62948-3150
(618) 942-3344
(618) 942-5045
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
07/10/2006
Last updated
07/29/2008
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