NPIMap

Organization Active NPI

Loop Dermatology & Acne Care Center LLC

  • Clinic/Center
  • Chicago, IL
National Provider Identifier
1104093483
Registry record updated Nov 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
03610878 Issued in IL
Legal business name
LOOP DERMATOLOGY & ACNE CARE CENTER LLC
Practice address
111 N Wabash Ave
Suite 2001
Chicago, IL 60602-1903
Phone
(312) 519-1465
NPI assigned
May 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michele Burgess, MD
Title
Owner
Phone
(312) 519-1465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 03610878 IL Primary

Addresses

Primary practice location

111 N Wabash Ave
Suite 2001
Chicago, IL 60602-1903

Mailing address

111 N Wabash Ave
Suite 2001
Chicago, IL 60602-1903
Phone (312) 519-1465

National Provider Directory

National Provider Directory

Locations

111 N Wabash Ave
Ste 2001
Chicago, IL 60602
Phone (312) 519-1465

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383696000000",
    "number": "1104093483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N WABASH AVE",
            "address_2": "SUITE 2001",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021903",
            "telephone_number": "312-519-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N WABASH AVE",
            "address_2": "SUITE 2001",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021903",
            "telephone_number": "312-519-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOOP DERMATOLOGY & ACNE CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2013-11-06",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-519-1465",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "03610878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.