NPI 1205464146

Adam David Souchik, MD

Practitioner Dermatology Physician Maywood, IL

Practice location

Address: 2160 S 1st Ave Fahey Bldg./Room 101, Maywood, IL 60153-3328
Phone: (708) 216-4962
Fax: (708) 216-2444
Mailing address: 1475 Granary Rd, Blue Bell, PA 19422-2155

Registered specialties (2)

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence 125077603 (IL)

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1205464146
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Mar 2020
Record last updated: 21 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.