Provider Demographics
NPI:1609009380
Name:PINNACLE DERMATOLOGY, SC
Entity Type:Organization
Organization Name:PINNACLE DERMATOLOGY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-744-8554
Mailing Address - Street 1:5141 VIRGINIA WAY
Mailing Address - Street 2:STE 350
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:629-666-2462
Mailing Address - Fax:629-666-2462
Practice Address - Street 1:3655 PLYMOUTH BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3664
Practice Address - Country:US
Practice Address - Phone:612-486-4200
Practice Address - Fax:612-486-4201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE DERMATOLOGY, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-28
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN059266800Medicaid