Calumet Dermatology Assoc S C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CALUMET DERMATOLOGY ASSOC S C

Practice address

19 River Oaks Drive
Calumet City, IL 60409

Phone

(708) 862-1290

Fax

(708) 862-6447

NPI assigned

Sep 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary Y Garcia

Title

Office Manager

Phone

(708) 862-1290

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Loris A Tisocco MD Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1003915166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 RIVER OAKS DRIVE",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "60409",
            "telephone_number": "708-862-1290",
            "fax_number": "708-862-6447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 RIVER OAKS DRIVE",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "60409",
            "telephone_number": "708-862-1290",
            "fax_number": "708-862-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALUMET DERMATOLOGY ASSOC S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-862-1290",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS OF INDIANA",
            "identifier": "000000239604",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loris A Tisocco MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• C&C on Time Express LLC
• Elva Caballero, CCC-SLP
• Mahriescel Cablarda
• Calumet City School District #155
• Calumet Counseling and Dui Services,Inc
• Lashonda Cameron, LCSW
• Terrence Eugene Campbell
• Tamarah Carpenter
• Guadalupe Castaneda Jr.
• Cathleen Ann Cavender, O.D.

• Dermatology Physician in Calumet City, IL
• Providers in Calumet City, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.