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LAKE SHORE DERMATOLOGY, LTD.
NPI 1902977937
Dermatology in Park City, IL

Active since November 13, 2006CLIA 14D2114254 · Certificate of Compliance
351 S. GREENLEAF, SUITE E, PARK CITY, IL 60085(847) 680-7100(847) 406-3345 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lake Shore Dermatology, Ltd. NPPES

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

LAKE SHORE DERMATOLOGY, LTD. (NPI 1902977937) is a healthcare organization registered as a dermatology in Park City, Illinois and active in the NPI registry since November 2006. The organization holds a CLIA Certificate of Compliance certificate valid through October 18, 2026 and lists Kavitha Gandhi, President, as its authorized official.

NPPES Registry Identity

NPI1902977937
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameLAKE SHORE DERMATOLOGY, LTD.
Location Address351 S. GREENLEAF, SUITE EPark City, IL 60085
Mailing Address351 S. Greenleaf, Suite EPark City, IL 60085 · (847) 680-7100 · Fax (847) 406-3345
Phone(847) 680-7100
Fax(847) 406-3345
Organization SubpartNo
Authorized OfficialKavitha GandhiPresident · (847) 680-7100
Enumeration DateNovember 13, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1902977937 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
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.
351 S. GREENLEAF, Park City, IL 60085
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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 14D2114254

Lake Shore Dermatology · Vernon Hills, IL
Active · expires Oct 18, 2026
CLIA Number14D2114254
Laboratory TypePhysician Office
Certificate Effective DateOctober 19, 2024
Certificate Expiration DateOctober 18, 2026
Laboratory DirectorWenhua Liu
Laboratory Phone(847) 680-7100
Laboratory LocationLake Shore Dermatology270 East Center Dr, Ste 130, Vernon Hills, IL 60061
CLIA data matches this NPI record on: Name 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

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

KAVITHA GANDHI M.D.
Dermatology
351 S. GREENLEAF, SUITE E
PARK CITY, IL 60085
Lake County (847) 680-7100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Shore Dermatology, Ltd.'s NPI number?

The NPI number for Lake Shore Dermatology, Ltd. is 1902977937. It was assigned to this organization in the NPPES registry on November 13, 2006.

Where is Lake Shore Dermatology, Ltd. located?

Lake Shore Dermatology, Ltd. is located at 351 S. Greenleaf Suite E, Park City, IL 60085. The listed phone number is (847) 680-7100.

What is Lake Shore Dermatology, Ltd.'s specialty?

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

Does Lake Shore Dermatology, Ltd. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 14D2114254) is associated with this NPI, valid through October 18, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake Shore Dermatology, Ltd. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.