Organization
VITALSKIN MEDICAL GROUP IL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN WIENS (CHIEF FINANCIAL OFFICER)
(704) 534-1854
Entity
Organization
Contact information
Practice address
2857 CHARLESTOWN RD STE 100, NEW ALBANY, IN 47150-1998
(129) 447-5008
Mailing address
1111 W KENYON RD, URBANA, IL 61801-1010
(858) 735-4059
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
04/21/2022
Last updated
08/12/2024
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