Provider Demographics
NPI:1124675244
Name:AIRIA COMPREHENSIVE DERMATOLOGY
Entity type:Organization
Organization Name:AIRIA COMPREHENSIVE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRACOFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-781-0214
Mailing Address - Street 1:618 W FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1144
Mailing Address - Country:US
Mailing Address - Phone:847-766-0829
Mailing Address - Fax:
Practice Address - Street 1:618 W FULTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1144
Practice Address - Country:US
Practice Address - Phone:847-766-0829
Practice Address - Fax:847-892-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty