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Organization
PURE SKINOLOGY LLC
Active
Organization
PURE SKINOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID OTHMAN MD (PRESIDENT)
(312) 600-5826
Entity
Organization
Contact information
Practice address
2202 N. HALSTED ST, SUITE 1, CHICAGO, IL 60614
(773) 270-1133
Mailing address
2202 N. HALSTED ST, SUITE 1, CHICAGO, IL 60614
(312) 600-5826
(608) 713-8272
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
NULL
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
NULL
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
NULL
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
NULL
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
NULL
207NS0135X
Procedural Dermatology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
NULL
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/25/2020
Last updated
07/15/2020
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