Provider Demographics
NPI:1154488401
Name:PINSKI DERMATOLOGY & COSMETIC SURGERY SC
Entity Type:Organization
Organization Name:PINSKI DERMATOLOGY & COSMETIC SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-263-4625
Mailing Address - Street 1:150 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7553
Mailing Address - Country:US
Mailing Address - Phone:312-263-4625
Mailing Address - Fax:
Practice Address - Street 1:150 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7553
Practice Address - Country:US
Practice Address - Phone:312-263-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042000198207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID