Provider Demographics
NPI:1275013450
Name:ADVANCED DERMATOLOGY AND AESTHETIC MEDICINE
Entity Type:Organization
Organization Name:ADVANCED DERMATOLOGY AND AESTHETIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-802-9667
Mailing Address - Street 1:351 W DICKENS AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4615
Mailing Address - Country:US
Mailing Address - Phone:402-319-4146
Mailing Address - Fax:
Practice Address - Street 1:850 S WABASH AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3642
Practice Address - Country:US
Practice Address - Phone:847-802-9667
Practice Address - Fax:408-715-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131459207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty