Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jun 10, 2024
License(s)
4351052598 (MI), 125.085812 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1922 W OGDEN AVE UNIT 907 | Chicago, IL 60612-5584 | 248-338-5000 |
| LOCATION | 820 S WOOD ST | Chicago, IL 60612-4325 | 312-996-2933 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.