Provider Demographics
NPI:1588283253
Name:PROFFER, SYDNEY LARKIN (MD, MS)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LARKIN
Last Name:PROFFER
Suffix:
Gender:
Credentials:MD, MS
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:CONRAD
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:228 W HILL ST APT 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3631
Mailing Address - Country:US
Mailing Address - Phone:513-600-5650
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 2020
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2994
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68967207N00000X
TXU3625207ND0101X
IL036.168455207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery