Provider Demographics
NPI:1841371184
Name:COLLETTE ARA HONORE MDSC
Entity type:Organization
Organization Name:COLLETTE ARA HONORE MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARA HONORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-404-1602
Mailing Address - Street 1:4938 S WASHINGTON PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5512
Practice Address - Country:US
Practice Address - Phone:773-667-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH60103Medicare UPIN