Provider Demographics
NPI:1194185280
Name:CHICAGO DERMATOLOGY AND COSMETIC CENTER, LTD
Entity Type:Organization
Organization Name:CHICAGO DERMATOLOGY AND COSMETIC CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-243-1188
Mailing Address - Street 1:2861 83RD ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5612
Mailing Address - Country:US
Mailing Address - Phone:630-590-5017
Mailing Address - Fax:630-590-5018
Practice Address - Street 1:2861 83RD ST
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5612
Practice Address - Country:US
Practice Address - Phone:630-590-5017
Practice Address - Fax:630-590-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty