Organization
ILLINOIS DERMATOLOGY INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN MANDREA M.D. (PHYSICIAN)
(847) 298-1831
Entity
Organization
Contact information
Practice address
1550 N NORTHWEST HWY, SUITE 300, PARK RIDGE, IL 60068-1411
(847) 298-1831
(847) 298-1832
Mailing address
1550 N NORTHWEST HWY, SUITE 300, PARK RIDGE, IL 60068-1411
(847) 298-1831
(847) 298-1832
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
036111710
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111710
—
IL
01
—
1386663631
NPI
IL
Enumeration date
04/01/2016
Last updated
04/01/2016
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