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LORIS A TISOCCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
19 RIVER OAKS DR, CALUMET CITY, IL 60409
(708) 862-1290
(708) 862-6447
Mailing address
580 E BOUGHTON RD, STE A, BOLINGBROOK, IL 60440-2565
(815) 744-8554
(630) 495-1770

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036054667
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200015120A
IL
Enumeration date
03/24/2006
Last updated
01/28/2020
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