NORTHSIDE DERMATOLOGY S.C. NPI 1861943888

NPI Information

  • NPI: 1861943888
  • Provider Name: NORTHSIDE DERMATOLOGY, S.C.
  • Classification: Clinic/Center - 261QM2500X
  • Specialization: Medical Specialty
  • Entity Type: Organization
  • Address: 1663 W CARMEN AVE
    CHICAGO, IL
    ZIP 60640
  • Phone: (312) 420-7409

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NPI Details

NORTHSIDE DERMATOLOGY, S.C. is a medical specialty clinic center in Chicago, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). NORTHSIDE DERMATOLOGY, S.C. NPI is 1861943888. The provider is registered as an organization entity type.

The provider's business location address is:

1663 W CARMEN AVE
CHICAGO, IL
ZIP 60640-701
Phone: (312) 420-7409

The provider's authorized official is James A Ida .
The authorized official title is Practice Owner and has the following contact phone number (773) 293-7500.

The enumeration date for this NPI number is 10/14/2016 and was last updated on 4/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical Specialty036.132972ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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