Organization
ST JOSEPH DERMATOLOGY AND VEIN CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VASSILIOS ATHANASIOS DIMITROPOULOS M.D. (PHYSICIAN/ OWNER/ PRESIDENT)
(773) 351-2862
Entity
Organization
Contact information
Practice address
2500 NILES RD STE 10A, SAINT JOSEPH, MI 49085-3272
(773) 351-2862
(773) 358-2767
Mailing address
745 S PARK AVE, HINSDALE, IL 60521-4645
(773) 351-2862
(773) 358-2767
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301079801
MI
207ND0101X
MOHS-Micrographic Surgery Physician
4301079801
MI
207NS0135X
Procedural Dermatology Physician
4301079801
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194838045
—
MI
Enumeration date
07/25/2016
Last updated
01/26/2017
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