Provider Demographics
NPI:1306066923
Name:BIELINSKI DERMATOLOGY GROUP LLC
Entity type:Organization
Organization Name:BIELINSKI DERMATOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-3767
Mailing Address - Street 1:16105 S LA GRANGE RD
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:
Practice Address - Street 1:108 N WHITE ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2020
Practice Address - Country:US
Practice Address - Phone:708-636-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK28341Medicare ID - Type Unspecified
ILC43724Medicare UPIN
ILK28347Medicare ID - Type Unspecified
ILQ28419Medicare UPIN