Central Illinois Dermatology, S.c.

NPI #1548358054 in Peoria, Illinois

Provider Information

NPI Number: 1548358054
Entity Type: Organization
Organization Name: Central Illinois Dermatology, S.c.
Primary Specialty: Dermatology
Enumeration Date: Oct 10, 2006
Last Updated: Jul 13, 2010

Practice Location

Address: 5401 N KNOXVILLE AVE
Address 2: SUITE 115
City: Peoria
State: Illinois
ZIP Code: 61614-5095
Phone: (309) 691-2903

Authorized Official

Name: CHRISTOPHER T KROODSMA, M.D.
Title: PRESIDENT
Phone: (309) 691-2903

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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