Active NPI
Lissette Carmen Ortiz-Ferrer, M.D.
- Dermatology Physician
- Maywood, IL
National Provider Identifier
1609997998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 036-093739
- Practice address
- 2160 S 1St Ave
Building 101, Room 1752
Maywood, IL 60153-3328 - Phone
- (708) 216-9000
- Fax
- (708) 216-6269
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 036-093739 | IL | Primary |
Addresses
Primary practice location
2160 S 1St Ave
Building 101, Room 1752
Maywood, IL 60153-3328
Mailing address
2160 S 1St Ave
Building 101, Room 1752
Maywood, IL 60153-3328
Phone (708) 216-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-093739 | IL | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315612800000",
"number": "1609997998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2160 S 1ST AVE",
"address_2": "BUILDING 101, ROOM 1752",
"city": "MAYWOOD",
"state": "IL",
"postal_code": "601533328",
"telephone_number": "708-216-9000",
"fax_number": "708-216-6269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2160 S 1ST AVE",
"address_2": "BUILDING 101, ROOM 1752",
"city": "MAYWOOD",
"state": "IL",
"postal_code": "601533328",
"telephone_number": "708-216-9000",
"fax_number": "708-216-6269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTIZ-FERRER",
"first_name": "LISSETTE",
"middle_name": "CARMEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2011-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "IL",
"license": "036-093739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maywood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.