NPI | 1386118057 |
---|---|
Entity Type | Organization |
Authorized Contact | AMY DERICK Medical Director 847-381-8899 |
Organization Subpart ? | No |
Primary Taxonomy | 207N00000X Dermatology |
Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
Enumeration Date | 2019-01-16 |
Last Update Date | 2022-09-09 |