Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036078458 | IL |
N | 207NS0135X | Procedural Dermatology | 036078458 | IL |
NPI | 1003973413 |
---|---|
Provider Name | Dr. Kevin Scott Pinski |
First Address | Chicago, IL 60601-7553 |
Second Address | Chicago, IL 60601-7553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E22353 | (02) |