Provider Demographics
NPI:1528737715
Name:SPECTRUM DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:SPECTRUM DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAYE
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 STE 350
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2394 N ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2459
Practice Address - Country:US
Practice Address - Phone:480-948-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM DERMATOLOGY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-10
Last Update Date:2022-02-25
Deactivation Date:2021-12-22
Deactivation Code:
Reactivation Date:2022-02-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site