Provider Demographics
NPI:1629478714
Name:AB DERMATOLOGY LLC
Entity Type:Organization
Organization Name:AB DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SULEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-542-9942
Mailing Address - Street 1:159 S BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1434
Mailing Address - Country:US
Mailing Address - Phone:630-529-5950
Mailing Address - Fax:630-529-6286
Practice Address - Street 1:159 S BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1434
Practice Address - Country:US
Practice Address - Phone:630-529-5950
Practice Address - Fax:630-529-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty