| NPI | 1215383666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE J M BEAIRD Owner 224-484-0183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology |
| 207NP0225X Dermatology, Pediatric Dermatology | |
| 207NS0135X Dermatology, Procedural Dermatology | |
| 363AM0700X Physician Assistant, Medical | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| 207ND0900X Dermatology, Dermatopathology | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2019-09-26 |