Organization
PREMIER DERMATOLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW R KELLEHER M.D. (MEDICAL DIRECTOR)
(815) 741-4343
Entity
Organization
Contact information
Practice address
2051 PLAINFIELD RD, CREST HILL, IL 60403-1865
(815) 741-4343
(815) 741-8660
Mailing address
2051 PLAINFIELD RD, CREST HILL, IL 60403-1865
(815) 741-4343
(815) 741-8660
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009900257
BCBS OF IL PROVIDER #
IL
Enumeration date
05/24/2006
Last updated
07/15/2010
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