Organization
DERMATOLOGY SPECIALIST, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY KIRSCHENBAUM M.D (PHYSICIAN)
77332714442
Entity
Organization
Contact information
Practice address
2740 W FOSTER AVE SUITE 305, CHICAGO, IL 60625
(773) 271-4442
(773) 271-4474
Mailing address
2740 W FOSTER AVE SUITE 305, CHICAGO, IL 60625
(773) 271-4442
(773) 271-4474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036035278
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036035278
—
IL
01
—
DG9713
RAIL ROAD MEDICARE
IL
Enumeration date
10/02/2006
Last updated
05/13/2008
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