Healthcare Provider Details

I. General information

NPI: 1982765624
Provider Name (Legal Business Name): JEFFREY E KARABAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N SHERIDAN ROAD #210
CHICAGO IL
60657-6156
US

IV. Provider business mailing address

2800 N SHERIDAN ROAD #210
CHICAGO IL
60657-6156
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-0046
  • Fax: 773-281-0228
Mailing address:
  • Phone: 773-281-0046
  • Fax: 773-281-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG51496
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JEFFREY E KARABAN
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 773-281-0046