Provider Demographics
NPI:1801285929
Name:MEDICAL DERMATOLOGY ASSOCIATES OF CHICAGO, LTD
Entity type:Organization
Organization Name:MEDICAL DERMATOLOGY ASSOCIATES OF CHICAGO, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-995-1955
Mailing Address - Street 1:363 W ERIE ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6903
Mailing Address - Country:US
Mailing Address - Phone:312-995-1955
Mailing Address - Fax:312-995-1956
Practice Address - Street 1:363 W ERIE ST
Practice Address - Street 2:SUITE 350
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6903
Practice Address - Country:US
Practice Address - Phone:312-995-1955
Practice Address - Fax:312-995-1956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty