Provider Demographics
NPI:1730188061
Name:BAKAL DERMATOLOGY ASSOCIATES, S.C.
Entity type:Organization
Organization Name:BAKAL DERMATOLOGY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-882-9300
Mailing Address - Street 1:1786 MOON LAKE BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1016
Mailing Address - Country:US
Mailing Address - Phone:847-882-9300
Mailing Address - Fax:847-882-9348
Practice Address - Street 1:1786 MOON LAKE BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1016
Practice Address - Country:US
Practice Address - Phone:847-882-9300
Practice Address - Fax:847-882-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X, 363A00000X, 363AM0700X, 363AS0400X, 207ND0900X, 207NP0225X, 207NS0135X, 207N00000X
IL085002837363AM0700X
IL085001122363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1621016OtherBCBS
IL207730Medicare ID - Type Unspecified