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General NPI Number Information
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NPI Number | 1386675171
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Entity Type | Organization
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Legal Business Name | DERMUSS LTD
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 905 FOX GLEN CT
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City | BARRINGTON
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State | IL
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Zip | 60010-1863
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Country | US
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Telephone | 847-277-1200
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Fax | 847-277-1209
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Provider Business Mailing Address
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Address Line | 905 FOX GLEN CT
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City | BARRINGTON
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State | IL
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Zip | 60010-1863
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Country | US
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Telephone | 847-277-1200
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Fax | 847-277-1209
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Authorized Official
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Title or Position | DOCTOR
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Name | UNA SHAH
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Credential | MD
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Telephone | 847-277-1200
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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 | 036102086
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License Number State | IL
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