Organization · NPI-2

901 Skinmd PLLC

Dermatology · Cordova, TN

NPI number1346719085
StatusActive
Last updated in NPPESMay 18, 2023

Details

NPI
1346719085
Entity type
Organization (NPI-2)
Legal business name
901 Skinmd PLLC
Organization subpart
No
Enumeration date
Nov 23, 2018
Certification date
May 18, 2023
Last updated
May 18, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207N00000X Dermatology––Yes

Practice location

751 Walnut Knoll Lane
Suite 2
Cordova, TN 38018-6301

Phone 781-467-8632

Mailing address

10020 Iberville Cv
Lakeland, TN 38002-7804

Phone 781-467-8632

Authorized official

Radoslaw Bieniek
Physician
7814678632

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