Healthcare Provider Details

I. General information

NPI: 1437014735
Provider Name (Legal Business Name): MANDEL DERMATOLOGY CHICAGO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST STE 801
CHICAGO IL
60611-2912
US

IV. Provider business mailing address

45 NORTHERN BLVD
GREENVALE NY
11548-1346
US

V. Phone/Fax

Practice location:
  • Phone: 312-395-7400
  • Fax:
Mailing address:
  • Phone: 312-395-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MITHCELL MANDEL
Title or Position: OWNER
Credential: MD
Phone: 646-350-4023