Northside Dermatology & Laser Center, S.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTHSIDE DERMATOLOGY & LASER CENTER, S.C.

Practice address

6211 N Milwaukee Ave
Chicago, IL 60646-3730

Phone

(773) 774-6677

Fax

(773) 774-3322

NPI assigned

Sep 23, 2024

Organization subpart

No

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

Authorized official

Name

Aneta Perez

Title

Manager

Phone

(847) 529-5255

Specialties & licenses 1

Addresses

Other names 1

• NORTHSIDE DERMATOLOGY & LASER CENTER, S.C. Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miroslawa Alina Dulczewska Miller, MD PHD

  • Legal Medicine
  • Chicago, IL
  • NPI 1013963537
  Medicare reassignment

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

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1326865353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6211 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606463730",
            "telephone_number": "773-774-6677",
            "fax_number": "773-774-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6211 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606463730",
            "telephone_number": "773-774-6677",
            "fax_number": "773-774-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE DERMATOLOGY & LASER CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-22",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "ANETA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-529-5255"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHSIDE DERMATOLOGY & LASER CENTER, S.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northshore Pediatrics Associates,S.C.
• Northshore Physicians LTD.
• Northside Center for Relationship Counseling
• Northside Center for Relationship Counseling
• Northside Chiropractic Inc
• Northside Dermatology, S.C.
• Northside Foot & Ankle PC
• Northside Foot & Ankle PC
• Northside Lab Inc
• Northside Neonatal and Infant Care SC

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.