Healthcare Provider Details

I. General information

NPI: 1336873546
Provider Name (Legal Business Name): ORISEK AND MCCASKILL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 CAVITT STALLMAN RD STE 100A
GRANITE BAY CA
95746-9049
US

IV. Provider business mailing address

4080 CAVITT STALLMAN RD STE 100A
GRANITE BAY CA
95746-9049
US

V. Phone/Fax

Practice location:
  • Phone: 916-771-0715
  • Fax:
Mailing address:
  • Phone: 916-771-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHEL MAXSOM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 916-871-5624