# NORTHSIDE DERMATOLOGY, S.C.

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

## Provider details

- **NPI number:** 1861943888
- **Authorized official:** DR. JAMES A IDA (PRACTICE OWNER)
- **Authorized official phone:** (773) 293-7500

## Contact information

- **Practice address:** 1663 W CARMEN AVE, CHICAGO, IL 60640-2701
- **Practice address phone:** (312) 420-7409
- **Mailing address:** 1663 W CARMEN AVE, CHICAGO, IL 60640-2701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036.132972 | IL | Yes |

## Other

- **Enumeration date:** 10/14/2016
- **Last updated:** 04/20/2020