Academic Dermatology & Skin Cancer Institute, SC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

042618008 Issued in IL

Legal business name

ACADEMIC DERMATOLOGY & SKIN CANCER INSTITUTE, SC

Practice address

50 E Washington St Ste 200
Chicago, IL 60602-2154

Phone

(312) 230-0180

Fax

(312) 230-0181

NPI assigned

Feb 27, 2007

Last updated

Jan 15, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ana Balich

Title

Office Manager

Phone

(312) 230-0180

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1902933146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809397",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606809397",
            "telephone_number": "312-230-0180",
            "fax_number": "312-230-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E WASHINGTON ST STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606022154",
            "telephone_number": "312-230-0180",
            "fax_number": "312-230-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC DERMATOLOGY & SKIN CANCER INSTITUTE, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "BALICH",
        "authorized_official_first_name": "ANA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "312-230-0180"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "042618008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• MOHS-Micrographic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.