1902933146 NPI number — ACADEMIC DERMATOLOGY & SKIN CANCER INSTITUTE, SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902933146 NPI number — ACADEMIC DERMATOLOGY & SKIN CANCER INSTITUTE, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACADEMIC DERMATOLOGY & SKIN CANCER INSTITUTE, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902933146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 809397
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60680-9397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-230-0180
Provider Business Mailing Address Fax Number:
312-230-0181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 E WASHINGTON ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60602-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-230-0180
Provider Business Practice Location Address Fax Number:
312-230-0181
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALICH
Authorized Official First Name:
ANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
312-230-0180

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  042618008 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com