Healthcare Provider Details

I. General information

NPI: 1811816663
Provider Name (Legal Business Name): NORDIX DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 LINCOLN AVE
SKOKIE IL
60077-3612
US

IV. Provider business mailing address

8035 LINCOLN AVE
SKOKIE IL
60077-3612
US

V. Phone/Fax

Practice location:
  • Phone: 773-732-8625
  • Fax:
Mailing address:
  • Phone: 773-732-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MALLIA EIHENTALE
Title or Position: OWNER
Credential: DNP, FNP-BC, DCNP
Phone: 773-732-8625