Provider Demographics
NPI:1093377731
Name:KAMINSKA DERMATOLOGY
Entity Type:Organization
Organization Name:KAMINSKA DERMATOLOGY
Other - Org Name:KAMINSKA DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDIDIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-907-9820
Mailing Address - Street 1:1776 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5453
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:773-862-1454
Practice Address - Street 1:3000 N HALSTED ST STE 724
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5196
Practice Address - Country:US
Practice Address - Phone:708-628-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407083496OtherINDIVIDUAL NPI