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General NPI Number Information
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NPI Number | 1093377731
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Entity Type | Organization
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Legal Business Name | KAMINSKA DERMATOLOGY
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 09/02/2019
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST STE 724
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City | CHICAGO
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State | IL
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Zip | 60657-5196
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Country | US
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Telephone | 708-628-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 1776 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-5453
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Country | US
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Telephone | 312-926-3627
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Fax | 773-862-1454
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDIDIONG KAMINSKA
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Credential | MD
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Telephone | 901-907-9820
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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 |
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License Number State |
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