Organization
VILLAGE DERMATOLOGY, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CECELIA H RICKETTS MD (OWNER)
(847) 920-9177
Entity
Organization
Contact information
Practice address
401 LINDEN AVE, WILMETTE, IL 60091-2844
(847) 920-9177
(847) 920-9188
Mailing address
401 LINDEN AVE, WILMETTE, IL 60091-2844
(847) 920-9177
(847) 920-9188
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
042619944
IL
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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