Organization
MAVENA DERMA CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRI MCGINNIS (VICE PRESIDENT)
(847) 483-9621
Entity
Organization
Contact information
Practice address
1100 W CENTRAL RD, 306, ARLINGTON HEIGHTS, IL 60005-2402
(847) 483-9621
(847) 483-9625
Mailing address
500 N. MICHIGAN AVENUE, 300, CHICAGO, IL 60611-3777
(847) 298-9400
(847) 298-7660
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636236
BCBS
IL
Enumeration date
07/26/2006
Last updated
11/28/2007
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