Healthcare Provider Details

I. General information

NPI: 1962508556
Provider Name (Legal Business Name): NORTH SHORE DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 SKOKIE BLVD SUITE J
SKOKIE IL
60077-1384
US

IV. Provider business mailing address

9711 SKOKIE BLVD SUITE J
SKOKIE IL
60077-1384
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-9711
  • Fax: 847-675-9714
Mailing address:
  • Phone: 847-675-9711
  • Fax: 847-675-9714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID ALAN LORBER
Title or Position: OWNER
Credential: M.D.
Phone: 847-675-9711