Healthcare Provider Details

I. General information

NPI: 1376701623
Provider Name (Legal Business Name): EMILY L ARCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 N ELSTON AVE SUITE 110
CHICAGO IL
60642-1501
US

IV. Provider business mailing address

1765 N ELSTON AVE SUITE 110
CHICAGO IL
60642-1501
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-1100
  • Fax: 773-276-1102
Mailing address:
  • Phone: 773-276-1100
  • Fax: 773-276-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number241160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: