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General NPI Number Information
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NPI Number | 1023345758
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY-CHICAGO S C
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1131
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-372-0150
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Fax | 312-372-4249
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST SUITE 1131
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-372-0150
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Fax | 312-372-4249
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID BRYAN SHANKER
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Credential | M.D.
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Telephone | 312-372-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036064577
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License Number State | IL
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