| NPI | 1639670904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DERICK Medical Director 847-381-8899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 36112935) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2022-09-09 |