Prairie Dermatology, Pllc
NPI #1881333680 in Bloomington, Illinois
Provider Information
- NPI Number
- 1881333680
- Entity Type
- Organization
- Organization Name
- Prairie Dermatology, Pllc
- Primary Specialty
- Dermatology
- Enumeration Date
- May 31, 2022
- Last Updated
- Nov 23, 2022
Practice Location
- Address
- 1015 S MERCER AVE STE GF7
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61701-7107
- Phone
- (309) 660-8442
Authorized Official
- Name
- MICHAEL THOMAS GINNETTI, MD
- Title
- PHYSICIAN OWNER
- Phone
- (309) 531-1252
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dermatology |
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