Registry details
Type
Individual
Primary specialty
Dermatology, MOHS-Micrographic Surgery
Enumerated
Oct 27, 2005
License(s)
036107422 (IL), 036107422 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 680 N LAKE SHORE DR SUITE 1000 | Chicago, IL 60611-4546 | 312-695-6647 |
| MAILING | 676 N SAINT CLAIR ST STE 1600 | Chicago, IL 60611-2997 | 312-695-6647 |
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