CHICAGO COSMETIC SURGERY AND DERMATOLOGY SC - NPI 1407068000

Q: What is Chicago Cosmetic Surgery And Dermatology Sc's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

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About Chicago Cosmetic Surgery And Dermatology Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHICAGO COSMETIC SURGERY AND DERMATOLOGY SC (NPI 1407068000) is a healthcare organization registered as a dermatology in Chicago, Illinois and active in the NPI registry since May 2007. The organization lists Carolyn Jacob, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1407068000

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameCHICAGO COSMETIC SURGERY AND DERMATOLOGY SC

Location Address515 N STATE ST STE 900Chicago, IL 60654-9104

Mailing Address515 N State St Ste 900Chicago, IL 60654-9104 · (312) 245-9965 · Fax (312) 245-9964

Phone(312) 245-9965

Fax(312) 245-9964

Organization SubpartNo

Authorized OfficialCarolyn JacobMedical Director · (312) 245-9965

Enumeration DateMay 4, 2007

Last NPPES UpdateApril 14, 20262 updates tracked since enumeration

NPPES CertifiedApril 14, 2026

✔ NPI 1407068000 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in IL · 036-102098

Definition

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.

515 N STATE ST STE 900, Chicago, IL 60654

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Other Identifiers 1

Other1634805IL · Blue Cross Blue Shield

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 14D1029865

Chicago Cosmetic Surgery & Dermatology · Chicago, IL

Expired · Jul 31, 2026

CLIA Number14D1029865

Laboratory TypePhysician Office

Certificate Effective DateJuly 3, 2024

Certificate Expiration DateJuly 31, 2026

Laboratory DirectorCarolyn I. Jacob MD

Laboratory Phone(312) 245-9965

Laboratory LocationChicago Cosmetic Surgery & Dermatology515 N State - Ste 900, Chicago, IL 60654

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAROLINE SHEPPARD PA-C

Physician Assistant