Healthcare Provider Details

I. General information

NPI: 1861930984
Provider Name (Legal Business Name): PINNACLE DERMATOLOGY, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 ESSINGTON RD
JOLIET IL
60435-8423
US

IV. Provider business mailing address

PO BOX 734241
CHICAGO IL
60673-4241
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-8554
  • Fax: 815-744-3969
Mailing address:
  • Phone: 815-744-8554
  • Fax: 815-744-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036109103
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE L RIOS
Title or Position: VICE-PRESIDENT
Credential: MD
Phone: 630-388-9033