| NPI | 1225127244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA GOTTFREDSEN Administrator 847-480-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 042-618435) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-11-01 |