| NPI | 1003425836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONOR PATRICK DOLEHIDE Owner 815-215-8292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207ND0900X Dermatology, Dermatopathology | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2025-05-15 |