Provider Demographics
NPI:1447601414
Name:CENTER FOR DERMATOLOGY AND AESTHETIC MEDICINE, LLC
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY AND AESTHETIC MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FAIYAAZ
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KALIMULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-380-6747
Mailing Address - Street 1:755 N WELLS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3520
Mailing Address - Country:US
Mailing Address - Phone:312-380-6747
Mailing Address - Fax:312-348-7229
Practice Address - Street 1:755 N WELLS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3520
Practice Address - Country:US
Practice Address - Phone:312-380-6747
Practice Address - Fax:312-348-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139965207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty