Organization
901 SKINMD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RADOSLAW BIENIEK MD (PHYSICIAN)
(781) 467-8632
Entity
Organization
Contact information
Practice address
751 WALNUT KNOLL LANE, SUITE 2, CORDOVA, TN 38018-6301
(781) 467-8632
Mailing address
10020 IBERVILLE CV, LAKELAND, TN 38002-7804
(781) 467-8632
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083853006
NPPES
—
Enumeration date
11/23/2018
Last updated
05/18/2023
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