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General NPI Number Information
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NPI Number | 1336873546
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Entity Type | Organization
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Legal Business Name | ORISEK AND MCCASKILL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 4080 CAVITT STALLMAN RD STE 100A
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City | GRANITE BAY
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State | CA
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Zip | 95746-9049
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Country | US
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Telephone | 916-771-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 CAVITT STALLMAN RD STE 100A
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City | GRANITE BAY
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State | CA
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Zip | 95746-9049
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Country | US
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Telephone | 916-771-0715
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MICHEL MAXSOM
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Credential |
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Telephone | 916-871-5624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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