Provider Demographics
NPI:1265073415
Name:KAMINSKA DERMATOLOGY PLLC
Entity type:Organization
Organization Name:KAMINSKA DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:EDIDIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-677-4300
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:
Mailing Address - Fax:
Practice Address - Street 1:3808 N LINCOLN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:773-677-4300
Practice Address - Fax:773-423-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407083496OtherINDIVIDUAL NPI