Provider Demographics
NPI:1306883822
Name:GORDON H DERMAN MD SC
Entity type:Organization
Organization Name:GORDON H DERMAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:H
Authorized Official - Last Name:DERMAN MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-432-9200
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:740
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-432-9200
Mailing Address - Fax:312-432-9233
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:740
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-432-9200
Practice Address - Fax:312-432-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty