Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Sep 26, 2011
License(s)
036140469 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2900 N LAKE SHORE DR | Chicago, IL 60657-5640 | 773-665-3000 |
| MAILING | 512 N MCCLURG CT UNIT 1906 | Chicago, IL 60611-5359 |
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