Organization
CALUMET DERMATOLOGY ASSOC S C
Active
Other names
Loris A Tisocco MD
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY Y GARCIA (OFFICE MANAGER)
(708) 862-1290
Entity
Organization
Contact information
Practice address
19 RIVER OAKS DRIVE, CALUMET CITY, IL 60409
(708) 862-1290
(708) 862-6447
Mailing address
19 RIVER OAKS DRIVE, CALUMET CITY, IL 60409
(708) 862-1290
(708) 862-6447
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000239604
ANTHEM BCBS OF INDIANA
IN
Enumeration date
09/22/2006
Last updated
05/09/2012
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