Healthcare Provider Details

I. General information

NPI: 1487644217
Provider Name (Legal Business Name): AARON MICHAEL DWORIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 PARK AVE W SUITE 1 NORTH
HIGHLAND PARK IL
60035-2230
US

IV. Provider business mailing address

1160 PARK AVE W SUITE 1 NORTH
HIGHLAND PARK IL
60035-2230
US

V. Phone/Fax

Practice location:
  • Phone: 847-433-2620
  • Fax: 847-433-8727
Mailing address:
  • Phone: 847-433-2620
  • Fax: 847-433-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: