Provider Demographics
NPI:1407083496
Name:KAMINSKA, EDIDIONG (MD)
Entity Type:Individual
Prefix:DR
First Name:EDIDIONG
Middle Name:
Last Name:KAMINSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 N ASHLAND AVE UNIT 577452
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7783
Mailing Address - Country:US
Mailing Address - Phone:901-907-9820
Mailing Address - Fax:
Practice Address - Street 1:3808 N LINCOLN AVE
Practice Address - Street 2:STE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6065
Practice Address - Country:US
Practice Address - Phone:773-677-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136349207N00000X
IL036.133070207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265073415OtherORGANIZATIONAL NPI