Organization
JORDAN C. CARQUEVILLE, MD LLC
Active
Other names
Derm Institute of Chicago
Organization subpart
No
Provider details
NPI number
Authorized official
MARC WEZOWSKI MS, JD (MANAGING DIRECTOR)
(312) 319-1978
Entity
Organization
Contact information
Practice address
737 N MICHIGAN AVE STE 720, CHICAGO, IL 60611-6661
(312) 319-1978
(312) 262-7791
Mailing address
920 N YORK RD STE 100, HINSDALE, IL 60521-3515
(312) 319-1978
(312) 262-7791
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
07/31/2019
Last updated
01/11/2025
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