| Ajay Kailas, | |
| 401 Linden Ave, Wilmette, IL 60091-2844 | |
| (847) 843-3376 | |
| (847) 920-9188 | 
| Full Name | Ajay Kailas | 
|---|---|
| Gender | Male | 
| Speciality | Dermatology | 
| Location | 401 Linden Ave, Wilmette, Illinois | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1053809715 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207N00000X | Dermatology | 036.158642 (Illinois) | Primary | 
| Entity Name | Soderstrom Dermatology Center S C. | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1710931670 PECOS PAC ID: 2062432651 Enrollment ID: O20051128000693 | 
| Entity Name | Forefront Dermatology Sc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1053783308 PECOS PAC ID: 3779471701 Enrollment ID: O20151130001424 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Ajay Kailas, 801 York St, Manitowoc, WI 54220-4630 Ph: (920) 663-9008 | Ajay Kailas, 401 Linden Ave, Wilmette, IL 60091-2844 Ph: (847) 843-3376 | 
| Dr. Virginia Carol Fiedler, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 1921 Lake Ave, Suite C, Wilmette, IL 60091 Phone: 847-920-1700 Fax: 847-920-1739 | |
| Liborka Kos, M.D. Dermatology Medicare: Medicare Enrolled Practice Location: 3232 Lake Ave, Wilmette, IL 60091 Phone: 847-318-9330 | |
| Dr. Cecelia H. Ricketts, M.D. Dermatology Medicare: Not Enrolled in Medicare Practice Location: 401 Linden Ave, Wilmette, IL 60091 Phone: 847-920-9177 Fax: 847-920-9188 | |
| Dr. Gerta S Janss, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 711 11th St, Wilmette, IL 60091 Phone: 847-920-0225 |