Organization
CARDINAL DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIZ CARLOS PANTALENA FILHO MD, PHD (MEMBER)
(650) 387-9765
Entity
Organization
Contact information
Practice address
4322 LAFAYETTE BLVD, SOUTH BEND, IN 46614
(574) 391-1111
Mailing address
4322 S LAFAYETTE BLVD, SOUTH BEND, IN 46614-2189
(574) 391-1111
(574) 859-5040
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
12/11/2023
Last updated
01/02/2025
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