Healthcare Provider Details

I. General information

NPI: 1306992128
Provider Name (Legal Business Name): CLEAR COMPLEXIONS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E. GOLF ROAD
SCHAUMBURG IL
60173-4511
US

IV. Provider business mailing address

705 E. GOLF ROAD
SCHAUMBURG IL
60173-4511
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-0200
  • Fax: 847-843-0281
Mailing address:
  • Phone: 847-843-0200
  • Fax: 847-843-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036078464
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036078464
License Number StateIL

VIII. Authorized Official

Name: DR. HANK NICHAMIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 847-843-0200