Provider Demographics
NPI:1306992128
Name:CLEAR COMPLEXIONS LTD.
Entity type:Organization
Organization Name:CLEAR COMPLEXIONS LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-843-0200
Mailing Address - Street 1:705 E. GOLF ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4511
Mailing Address - Country:US
Mailing Address - Phone:847-843-0200
Mailing Address - Fax:847-843-0281
Practice Address - Street 1:705 E. GOLF ROAD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4511
Practice Address - Country:US
Practice Address - Phone:847-843-0200
Practice Address - Fax:847-843-0281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEAR COMPLEXIONS LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078464261QM2500X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208763Medicare PIN
ILE62212Medicare UPIN