Healthcare Provider Details

I. General information

NPI: 1144726555
Provider Name (Legal Business Name): ROSS PEARLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 W ERIE ST STE 350
CHICAGO IL
60654-6933
US

IV. Provider business mailing address

13001 E 17TH PL
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 312-995-1955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036.161153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: