Provider Demographics
NPI:1114063591
Name:DERMATOLOGY PARTNERS OF THE NORTH SHORE LLC
Entity Type:Organization
Organization Name:DERMATOLOGY PARTNERS OF THE NORTH SHORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DRALUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-272-4433
Mailing Address - Street 1:400 SKOKIE BLVD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7930
Mailing Address - Country:US
Mailing Address - Phone:847-272-4433
Mailing Address - Fax:
Practice Address - Street 1:400 SKOKIE BLVD
Practice Address - Street 2:SUITE 475
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7930
Practice Address - Country:US
Practice Address - Phone:847-272-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL549020Medicare ID - Type UnspecifiedGROUP NUMBER