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Organization

AESTHETIC DERMATOLOGY JONITH Y BREADON MD LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JONITH BREADON MD (OWNER-PROPRIETOR-HEAD PHYSICIAN)
(312) 733-2498
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
31602551
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/22/2007
Last updated
04/20/2008
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