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General NPI Number Information
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NPI Number | 1265073415
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Entity Type | Organization
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Legal Business Name | KAMINSKA DERMATOLOGY PLLC
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 3808 N LINCOLN AVE SUITE 101
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 773-677-4300
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Fax | 773-423-8429
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Provider Business Mailing Address
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Address Line | 3024 N ASHLAND AVE UNIT 577452
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City | CHICAGO
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State | IL
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Zip | 60657-7783
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR AND FOUNDER
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Name | EDIDIONG KAMINSKA
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Credential | MD
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Telephone | 773-677-4300
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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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