Provider Demographics
NPI:1366497554
Name:BIELINSKI DERMATOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:BIELINSKI DERMATOLOGY GROUP, LLC
Other - Org Name:SKINMD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-3767
Mailing Address - Street 1:16105 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5503
Mailing Address - Country:US
Mailing Address - Phone:708-636-3767
Mailing Address - Fax:708-636-4361
Practice Address - Street 1:16105 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5503
Practice Address - Country:US
Practice Address - Phone:708-636-3767
Practice Address - Fax:708-636-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070977207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29544Medicare ID - Type UnspecifiedDR.BIELINSKI
ILQ28419Medicare UPIN
ILD12971Medicare UPIN
ILK28344Medicare ID - Type UnspecifiedDR.BIELINSKI
ILK28347Medicare ID - Type UnspecifiedKARIE HALL PA-C
ILK28341Medicare ID - Type UnspecifiedDR.KEANE
ILC43724Medicare UPIN
ILK29543Medicare ID - Type UnspecifiedKARIE HALL PA-C