| NPI | 1649807074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID OTHMAN President 312-600-5826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Additional Taxonomies | 207N00000X Dermatology |
| 207ND0101X Dermatology MOHS-Micrographic Surgery | |
| 207ND0900X Dermatology Dermatopathology | |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology | |
| 207NP0225X Dermatology Pediatric Dermatology | |
| 207NS0135X Dermatology Procedural Dermatology | |
| 261QA1903X Clinic/Center Ambulatory Surgical | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2020-07-15 |