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General NPI Number Information
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NPI Number | 1336507235
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY PHYSICIANS GROUP, LLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 2148 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4562
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Country | US
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Telephone | 731-698-6756
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Fax |
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Provider Business Mailing Address
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Address Line | 2156 W SCHOOL ST
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City | CHICAGO
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State | IL
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Zip | 60618-6312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | STEPHEN CARTER
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Credential | MD
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Telephone | 731-698-6756
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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 |
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License Number State |
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