Organization
DERMATOLOGY CONSULTANTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRVING H DISTELITEIM MD (PRESIDENT)
(773) 267-8820
Entity
Organization
Contact information
Practice address
6374 N LINCOLN AVE, SUITE 202, CHICAGO, IL 60659
(773) 267-8820
(773) 583-2118
Mailing address
6374 N LINCOLN AVE, SUITE 202, CHICAGO, IL 60659
(773) 267-8820
(773) 583-2118
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
03629454
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615765
BCBS
—
Enumeration date
10/29/2007
Last updated
10/29/2007
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