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General NPI Number Information
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NPI Number | 1306626676
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Entity Type | Organization
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Legal Business Name | MYSKIN LLC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 4751 N MALDEN ST APT 3S
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City | CHICAGO
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State | IL
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Zip | 60640-5195
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Country | US
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Telephone | 616-540-8473
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Fax |
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Provider Business Mailing Address
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Address Line | 4751 N MALDEN ST APT 3S
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City | CHICAGO
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State | IL
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Zip | 60640-5195
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Country | US
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Telephone | 616-540-8473
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | MRS. HEIDI SUE LAABS
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Credential |
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Telephone | 616-540-8473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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