Provider Demographics
NPI:1609827237
Name:NORTH SUBURBAN DERMATOLOGY ASSOCIATES,SC
Entity Type:Organization
Organization Name:NORTH SUBURBAN DERMATOLOGY ASSOCIATES,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-662-8201
Mailing Address - Street 1:1O3 S GREENLEAF ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3370
Mailing Address - Country:US
Mailing Address - Phone:847-662-8201
Mailing Address - Fax:847-662-8215
Practice Address - Street 1:1O3 S GREENLEAF ST
Practice Address - Street 2:SUITE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3370
Practice Address - Country:US
Practice Address - Phone:847-662-8201
Practice Address - Fax:847-662-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1356495030OtherDUBIN NPI
IL6945148002OtherCIGNA - SAMUEL SOLOMON
ILO4920144OtherBCBS PROVIDER NUMBER
IL1558316281OtherSOLOMON NPI
IL453550OtherMEDICARE GRP
IL4044905OtherAETNA - SAMUEL SOLOMON
IL7248829002OtherCIGNA- BENJAMIN DUBIN, MD
ILK39549OtherMDR INVIDUAL SOLOMON
ILK39550OtherMDR INDIVIDUAL DUBIN
IL4392571OtherAETNA- BENJAMIN DUBIN,MD
IL6945148002OtherCIGNA - SAMUEL SOLOMON
IL4044905OtherAETNA - SAMUEL SOLOMON
IL453550OtherMEDICARE GRP
ILE19023Medicare UPIN