MEDICARE: GOLDIN DERMATOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1487063335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDIN DERMATOLOGY LLC

Provider Business Mailing Address
First Line	:	4709 GOLF RD STE 1000
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1260
Country	:	US
Telephone Number	:	847-677-2080
Fax Number	:	847-677-2098

Provider Business Practice Location Address
First Line	:	4709 GOLF RD STE 1000
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1260
Country	:	US
Telephone Number	:	847-677-2080
Fax Number	:	847-677-2098

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	DR. HARRY MARK GOLDIN
Credential	:	MD
Telephone Number	:	847-677-2080

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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