| NPI | 1356553754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE A. JACKSON President, Owner, Medical Director 312-236-9950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036093014) |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2020-08-22 |