| NPI | 1497792618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY JANE DERICK Medical Director 847-381-8899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 36112935) |
| 207ZD0900X Pathology, Dermatopathology | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-09-09 |