Unknown Individual – Dermatology Physician, NPI 1164493417

Unknown Individual is a healthcare provider. based in Aurora, Illinois. specializing in Dermatology Physician. They hold a License No. 036055698 (IL). The NPI Number for Unknown Individual is 1164493417

Main info

Organization
Inactive
63 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164493417
Phone
(630) 892-6300
Address
1177 N HIGHLAND AVE
Deactivation Date
12 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1963 (63 years ago)
PAC ID
9436287273
Professional Enrollment ID
I20100514000415
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1177, North Highland Avenue, Aurora, Kane County, Illinois, 60506, United States

    AURORA, IL 605062281

    Phone: (630) 892-6300

    Fax: (630) 892-6379

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60506)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYIL11101Biopsy of each additional growth of skin and/or tissue3013

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1164493417 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Dermatology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Aurora, Illinois; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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