Provider Demographics
NPI:1194279463
Name:KIRSCHENBAUM DERMATOLOGY LLC
Entity type:Organization
Organization Name:KIRSCHENBAUM DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-3767
Mailing Address - Street 1:16105 S LAGRANGE ROAD
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:708-590-7148
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE# 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3510
Practice Address - Country:US
Practice Address - Phone:773-271-4442
Practice Address - Fax:773-271-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036035278207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty