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General NPI Number Information
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NPI Number | 1639045321
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Entity Type | Organization
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Legal Business Name | PIONEER DERMATOLOGY LLC
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Dates
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Enumeration Date | 10/11/2025
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 1324 NE WINDSOR DR
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City | LEES SUMMIT
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State | MO
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Zip | 64086-8477
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Country | US
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Telephone | 816-944-1944
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Fax | 816-944-1030
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Provider Business Mailing Address
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Address Line | 1324 NE WINDSOR DR
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City | LEES SUMMIT
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State | MO
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Zip | 64086-8477
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Country | US
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Telephone | 816-944-1944
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Fax | 816-944-1030
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Authorized Official
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Title or Position | PROVIDER/PARTNER
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Name | ANDREW S. BERG
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Credential | PA-C
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Telephone | 816-365-4161
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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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