Provider Demographics
NPI:1346719085
Name:901 SKINMD PLLC
Entity Type:Organization
Organization Name:901 SKINMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RADOSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENIEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-467-8632
Mailing Address - Street 1:10020 IBERVILLE CV
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7804
Mailing Address - Country:US
Mailing Address - Phone:781-467-8632
Mailing Address - Fax:
Practice Address - Street 1:751 WALNUT KNOLL LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6301
Practice Address - Country:US
Practice Address - Phone:781-467-8632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-23
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083853006OtherNPPES