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Organization
PINNACLE DERMATOLOGY, S.C.
Active
Organization
PINNACLE DERMATOLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE LUIS RIOS MD (VICE PRESIDENT)
(815) 744-8554
Entity
Organization
Contact information
Practice address
935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
(763) 220-8030
Mailing address
PO BOX 734240, CHICAGO, IL 60673-4240
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
NULL
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
NULL
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
09/10/2024
Last updated
09/26/2024
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