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Organization

DERMATOLOGY PHYSICIANS SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MOTUNRAYO ADISA MD (OWNER)
(773) 875-2029
Entity
Organization

Contact information

Practice address
680 N LAKE SHORE DR STE 1208, CHICAGO, IL 60611-8701
(312) 483-4397
Mailing address
640 N WELLS ST APT 1003, CHICAGO, IL 60654-3958
(773) 875-2029

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary

Other

Enumeration date
02/13/2019
Last updated
03/30/2020
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