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General NPI Number Information
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NPI Number | 1720814429
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Entity Type | Organization
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Legal Business Name | PINNACLE DERMATOLOGY, S.C.
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 935 WAYZATA BLVD E STE 200
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City | WAYZATA
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State | MN
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Zip | 55391-2513
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Country | US
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Telephone | 763-220-8030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734240
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City | CHICAGO
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State | IL
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Zip | 60673-4240
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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 | VICE PRESIDENT
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Name | JOSE LUIS RIOS
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Credential | MD
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Telephone | 815-744-8554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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