Provider Demographics
NPI:1063088235
Name:PINNACLE DERMATOLOGY, SC
Entity type:Organization
Organization Name:PINNACLE DERMATOLOGY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-634-4602
Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:708-634-4602
Mailing Address - Fax:630-495-1770
Practice Address - Street 1:820 SPRINGER DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6413
Practice Address - Country:US
Practice Address - Phone:815-744-8554
Practice Address - Fax:630-495-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory