DERMATOLOGY AND AESTHETICS OF WICKER PARK, LLC (NPI# 1386777241) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386777241 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGY AND AESTHETICS OF WICKER PARK, LLC |
| Practice Address |
1765 N Elston Ave Suite 110 Chicago IL 60642-1501 |
| Practice Telephone | 7732761100 |
| Practice Fax Number | 7732761102 |
| Mailing Telephone | 7732761100 |
| Mailing Fax Number | 7732761102 |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-11-03 |
| Authorized Official Name | NEHA D ROBINSON (DOCTOR) |
| Authorized Official Telephone | 7732761100 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Street Address |
1765 N ELSTON AVE SUITE 110 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60642-1501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831139344 | Meyer Horn | Dermatology | 1765 N Elston Ave, Suite 110, Chicago, IL 60642-1501 | 2006-06-07 |
| 1629676481 | Donna Bagdasarian | Physical Therapist | 1765 N Elston Ave, Chicago, IL 60642-1501 | 2020-10-14 |
| 1366056053 | Elizabeth Lorentzen | Speech-Language Pathologist | 1765 N Elston Ave, Chicago, IL 60642-1501 | 2020-09-01 |
| 1023620754 | Emily Ann Marie Firmiss | Speech-Language Pathologist | 1765 N Elston Ave, Chicago, IL 60642-1501 | 2020-08-24 |
| 1508406380 | Justine Rae Boudreau | Behavioral Analyst | 1765 N Elston Ave, Suite 206, Chicago, IL 60642-1501 | 2020-01-09 |
| 1629618673 | Caitlin O'connor | Speech-Language Pathologist | 1765 N Elston Ave, Chicago, IL 60642-1501 | 2020-01-07 |
| 1326511544 | Jennifer Herndon | Behavioral Analyst | 1765 N Elston Ave, Chicago, IL 60642-1501 | 2019-01-10 |
| 1831564848 | Natalie Theriault | Nurse Practitioner | 1765 N Elston Ave, Suite 110, Chicago, IL 60642-1501 | 2015-12-02 |
| 1053552240 | Monica Rani | Dermatology | 1765 N Elston Ave, Suite 1600, Chicago, IL 60642-1501 | 2009-03-17 |
| 1376701623 | Emily L Arch | Dermatology | 1765 N Elston Ave, Suite 110, Chicago, IL 60642-1501 | 2008-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134612542 | Lauren Gregorcy | Social Worker | 939 W. North Avenue, Suite 750, Chicago, Illinois, 6064, Office 720, Chicago, IL 60642 | 2018-06-11 |
| 1811409030 | Athletico Ltd | Physical Therapist | 819 W Blackhawk St, Ste 819b, Chicago, IL 60642 | 2017-10-27 |
| 1346759693 | Rachel Sherron | Counselor | 938 N Elston, #1, Chicago, IL 60642 | 2017-09-28 |
| 1639612831 | Empathic Resonance, LLC | Clinic/Center | 939 W North Ave Suite 750, Office 721, Chicago, IL 60642 | 2016-11-21 |
| 1053867317 | D Jamieson Brady | Dentist | 1249 N Greenview Ave Apt 1, Chicago, IL 60642 | 2016-08-28 |
| 1548646508 | Kathryn Lee | Massage Therapist | 742 N Ada St, Unit 1, Chicago, IL 60642 | 2015-07-31 |
| 1497149694 | Neda Bahrani | Family Medicine | 1460 N Halsted St Ste 401, Chicago, IL 60642 | 2015-03-25 |
| 1326439431 | Sarah Perez | Counselor | 1332 N. Cleaver St, Apt. 2rr, Chicago, IL 60642 | 2015-02-11 |
| 1780097105 | Michael Sotiriou | Dermatology | 1765 N Elston Ave Ste 110, Chicago, IL 60642 | 2014-06-03 |
| 1285067876 | Tyler Pere Choate | Speech-Language Pathologist | 400 N. May Street, Chicago, IL 60642 | 2013-08-19 |
| Find all providers in zip 60642 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346899630 | Jeremy Gantz Morse | Specialist | 815 W Buena Ave, Chicago, IL 60613-1694 | 2019-09-09 |
| 1619539632 | Benjamin Mendoza | Specialist | 6303 W 63rd St Unit 3c, Chicago, IL 60638-7015 | 2019-06-29 |
| 1811471808 | Judith M Penn | Specialist | 8312 S Kedzie Ave, Chicago, IL 60652-3309 | 2018-09-17 |
| 1841774825 | Matthew E Huggins | Specialist | 4553 W 56th St Apt 204c, Chicago, IL 60629-5389 | 2018-09-17 |
| 1750860177 | Muhammad Asim Khan | Specialist | 60 E Delaware Pl, Chicago, Il 60611, 14th Floor Urology- Andrology Clinic, Chicago, IL 60611 | 2018-08-07 |
| 1922502657 | Shauntay Robertson | Specialist | 7342 S Richmond St, Chicago, IL 60629-3015 | 2018-03-19 |
| 1114448644 | Ageless Men's Health Holdings Inc | Specialist | 1729 N Clybourn Ave, Chicago, IL 60614-6503 | 2017-07-06 |
| 1447798871 | Andria Miller | Specialist | 840 N Western Ave, Chicago, IL 60622-4638 | 2017-02-06 |
| 1710425129 | Rtb Sc | Specialist | 5015 N. Paulina #225, Chicago, IL 60640 | 2017-02-06 |
| 1881137354 | Joy Deliverance Williamson | Specialist | 3863 W Flournoy St, Apt. 1w, Chicago, IL 60624-3617 | 2016-11-30 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.