Provider Demographics
NPI:1083145536
Name:FINE DERMATOLOGY LLC
Entity Type:Organization
Organization Name:FINE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-275-3479
Mailing Address - Street 1:500 W SUPERIOR ST
Mailing Address - Street 2:#1803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8132
Mailing Address - Country:US
Mailing Address - Phone:847-275-3479
Mailing Address - Fax:
Practice Address - Street 1:500 W SUPERIOR ST
Practice Address - Street 2:#1803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8132
Practice Address - Country:US
Practice Address - Phone:847-275-3479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125993207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty