Lakeside Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036.114928 Issued in IL

Legal business name

LAKESIDE DERMATOLOGY

Practice address

1240 N Milwaukee Ave
Libertyville, IL 60048-1307

Phone

(847) 367-5575

Fax

(847) 367-5579

NPI assigned

Apr 13, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Martha P Arroyo, M.D.

Title

Owner

Phone

(847) 367-5575

Specialties & licenses 1

Addresses

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Subin M Jacob-George, PA-C

  • Physician Assistant
  • Worcester, MA
  • NPI 1831545995
  NPD (past)

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1508252875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 N MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481307",
            "telephone_number": "847-367-5575",
            "fax_number": "847-367-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 N MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481307",
            "telephone_number": "847-367-5575",
            "fax_number": "847-367-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "ARROYO",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-367-5575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.114928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "lakesidederm.ema.md/fhir/metadata",
            "affiliation": "N",
            "address_1": "1240 N Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600481307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lake County Plastic Surgery & Vein Center LLC
• Lake County Radiology Associates, S.C.
• Lake County Smile Doctors LTD
• Lake Forest Internal Medicine, LTD
• Lakeshore Physical Therapy, LLC
• Courtney Lamb, DDS
• Molly Lamb
• Bailey Lynn Lambert-Candaza, LCSW
• Michelle Marie Landis, MA, LCPC
• Martin Lanoff, M.D.

• Dermatology Physician in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.