| NPI | 1003026048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL SUTHERLAND Supervisor 847-459-6495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036038658) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036022673) |
| 207N00000X Dermatology (Licence: IL 036038658) | |
| 207N00000X Dermatology (Licence: IL 036022673) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: IL 036038658) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-06-19 |