Provider Type Icon

LEGACY DERMATOLOGY PLLC NPI 1053024554


NPI Information

NPI: 1053024554
Provider Name: LEGACY DERMATOLOGY PLLC
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 14D2276062

Address:
2230 HUNTINGTON DR N
ALGONQUIN, IL
ZIP 60102
Phone: (415) 802-1310
Get Directions

LEGACY DERMATOLOGY PLLC is a dermatology in Algonquin, IL. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. LEGACY DERMATOLOGY PLLC NPI is 1053024554. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2230 HUNTINGTON DR N
ALGONQUIN, IL
ZIP 60102-419
Phone: (415) 802-1310
Fax: (847) 960-3675

The provider's authorized official is Laurence Bradley .
The authorized official title is Md/owner and has the following contact phone number (415) 802-1310.

The CLIA number assigned to this NPI record is 14D2276062 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/29/2022 and was last updated on 5/22/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207ND0101XDermatologyMOHS-Micrographic SurgeryNo
2207NS0135XDermatologyProcedural DermatologyNo
3207N00000XDermatologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.