| NPI | 1104178144 |
|---|---|
| Doing Business As | DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | ANUP KUMAR CHAUDHRY Member 618-549-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036094335) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036094335) |
| Enumeration Date | 2012-10-14 |
| Last Update Date | 2012-10-14 |