Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Chicago Cosmetic Surgery and Dermatology SC

Organization Dermatology Physician · NPI 1407068000

Chicago Cosmetic Surgery and Dermatology SC is a Dermatology Physician in Chicago, Illinois. Licensed in Illinois. Registered with an NPI since 2007.

Licensed in
IL
In the registry since
2007

Practice location Address checks out

515 N State St Ste 900
Chicago, IL 60654-9104
Phone: (312) 245-9965
Fax: (312) 245-9964
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 036-102098 (IL)

Record details

NPI number1407068000
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Carolyn Jacob — Medical Director · (312) 245-9965
NPI enumeratedMay 4, 2007
Last updated in NPPESApril 14, 2026
Certification dateApril 14, 2026
Mailing address515 N State St Ste 900, Chicago, IL 60654-9104

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