Organization
DERMATOLOGY AND PLASTIC SURGERY ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE RIOS M.D. (V.P.)
(815) 744-8554
Entity
Organization
Contact information
Practice address
1124 ESSINGTON RD, JOLIET, IL 60435-8423
(815) 744-8554
(815) 744-3969
Mailing address
1124 ESSINGTON RD, JOLIET, IL 60435-8423
(815) 744-8554
(815) 744-3969
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
036108932
IL
208200000X
Plastic Surgery Physician
036109103
IL
363AM0700X
Medical Physician Assistant
085002224
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09932211
BC/BS GROUP NUMBER
IL
Enumeration date
09/26/2006
Last updated
03/22/2017
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