Southern Illinois Dermatology, PC

NPI #1306870233 in Herrin, Illinois

Provider Information

NPI Number: 1306870233
Entity Type: Organization
Organization Name: Southern Illinois Dermatology, PC
Primary Specialty: Dermatology
Enumeration Date: Jul 10, 2006
Last Updated: Jul 29, 2008

Practice Location

Address: 220 N PARK AVE
Address 2: SUITE 2
City: Herrin
State: Illinois
ZIP Code: 62948-3150
Phone: (618) 942-3344

Authorized Official

Name: DR. TED G VAN ACKER, D. O.
Title: PRESIDENT
Phone: (618) 942-3344

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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