Healthcare Provider Details

I. General information

NPI: 1790526812
Provider Name (Legal Business Name): THE DERM COLLECTIVE NORTH SHORE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SKOKIE BLVD STE 500
NORTHBROOK IL
60062-1618
US

IV. Provider business mailing address

40 SKOKIE BLVD STE 500
NORTHBROOK IL
60062-1618
US

V. Phone/Fax

Practice location:
  • Phone: 847-942-2204
  • Fax:
Mailing address:
  • Phone: 847-942-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL NEEMS PRITZKER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 847-942-2204