Healthcare Provider Details

I. General information

NPI: 1073575627
Provider Name (Legal Business Name): PINNACLE DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/26/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N HAVEN RD STE 7
ELMHURST IL
60126-2973
US

IV. Provider business mailing address

5141 VIRGINIA WAY STE 350
BRENTWOOD TN
37027-2319
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-2111
  • Fax: 630-832-5199
Mailing address:
  • Phone: 630-793-8185
  • Fax: 630-832-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036107390
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036107390
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: PAULA KAYE LAPINSKI
Title or Position: OWNER
Credential: MD
Phone: 815-744-8554