Organization
NORTHSHORE DERMATOLOGY CENTER SC
Active
Other names
Tina C Venetos MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TINA C VENETOS MD (PRESIDENT OF NORTHSHORE DERMATOLOGY)
(847) 234-1177
Entity
Organization
Contact information
Practice address
925 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 234-1177
(847) 234-1875
Mailing address
925 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 234-1177
(847) 234-1875
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036084683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01608107
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/20/2007
Last updated
03/31/2015
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