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General NPI Number Information
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NPI Number | 1023264967
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Entity Type | Organization
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Legal Business Name | PINSKI DERMATOLOGY & COSMETIC SURGERY SC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 374 LARRY POWER RD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5187
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Country | US
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Telephone | 815-933-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 374 LARRY POWER RD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5187
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Country | US
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Telephone | 815-933-2227
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ASHLEY F RIEMERTS
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Credential |
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Telephone | 312-263-4625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 042000198
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License Number State | IL
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