Organization
ROCKFORD DERMATOLOGY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAKIMERLY MICHELLE COATES MD (PRESIDENT)
(815) 399-6400
Entity
Organization
Contact information
Practice address
4338 MORSAY DR, ROCKFORD, IL 61107-4877
(815) 399-6400
(815) 399-4424
Mailing address
4338 MORSAY DR, ROCKFORD, IL 61107-4877
(815) 399-6400
(815) 399-4424
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
042617821
IL
207NS0135X
Procedural Dermatology Physician
042617821
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102903
—
IL
01
—
10132043
BLUE CROSS BLUE SHIELD
IL
01
—
203521
MEDICARE GROUP #
IL
01
—
7847308
AETNA
—
Enumeration date
09/20/2006
Last updated
02/19/2018
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