Organization
NORTHSIDE DERMATOLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES A IDA (PRACTICE OWNER)
(773) 293-7500
Entity
Organization
Contact information
Practice address
1663 W CARMEN AVE, CHICAGO, IL 60640-2701
(312) 420-7409
Mailing address
1663 W CARMEN AVE, CHICAGO, IL 60640-2701
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
036.132972
IL
Other
Enumeration date
10/14/2016
Last updated
04/20/2020
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