| NPI | 1710294756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CAMPBELL Sole Proprietor 708-450-5086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036120737) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036120737) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2011-03-04 |