# AESTHETIC DERMATOLOGY JONITH Y BREADON MD LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225163967
- **Authorized official:** DR. JONITH BREADON MD (OWNER-PROPRIETOR-HEAD PHYSICIAN)
- **Authorized official phone:** (312) 733-2498

## Contact information

- **Practice address:** 1009 W FULTON MARKET, CHICAGO, IL 60607-1222
- **Practice address phone:** (312) 733-2492
- **Practice address fax:** (312) 733-2498
- **Mailing address:** 1009 W FULTON MARKET, CHICAGO, IL 60607-1222
- **Mailing address phone:** (312) 733-2492
- **Mailing address fax:** (312) 733-2498

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | IL | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 31602551 | BLUE CROSS BLUE SHIELD | IL |