Lake Shore Dermatology, Ltd.

NPI #1902977937 in Park City, Illinois

Provider Information

NPI Number: 1902977937
Entity Type: Organization
Organization Name: Lake Shore Dermatology, Ltd.
Primary Specialty: Dermatology
Enumeration Date: Nov 13, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 351 S. GREENLEAF
Address 2: SUITE E
City: Park City
State: Illinois
ZIP Code: 60085
Phone: (847) 680-7100

Authorized Official

Name: DR. KAVITHA GANDHI, M.D.
Title: PRESIDENT
Phone: (847) 680-7100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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