Provider Demographics
NPI:1780829382
Name:CHICAGO SKIN SOLUTIONS, INC.
Entity Type:Organization
Organization Name:CHICAGO SKIN SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HULTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-205-2335
Mailing Address - Street 1:1111 W MADISON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2092
Mailing Address - Country:US
Mailing Address - Phone:312-770-7546
Mailing Address - Fax:
Practice Address - Street 1:1111 W MADISON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2092
Practice Address - Country:US
Practice Address - Phone:312-770-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094513261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center