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NPI Code Detail

MEDICARE: LAKESIDE DERMATOLOGY

MEDICARE: LAKESIDE DERMATOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician036.114928IL

General Provider Information

NPI Number : 1508252875
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESIDE DERMATOLOGY
Provider Business Mailing Address
First Line : 1240 N MILWAUKEE AVE
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-1307
Country : US
Telephone Number : 847-367-5575
Fax Number : 847-367-5579
Provider Business Practice Location Address
First Line : 1240 N MILWAUKEE AVE
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-1307
Country : US
Telephone Number : 847-367-5575
Fax Number : 847-367-5579
Authorized Official
Title or Position : OWNER
Name : DR. MARTHA P ARROYO
Credential : M.D.
Telephone Number : 847-367-5575
Provider Enumeration Date : 04/13/2015
Last Update Date : 12/15/2021

Similar Medicare Providers

1982156485 — MRS. ALLYSSA JEAN CLAPSADDLE PA-C
Practice Location Address:
1240 N MILWAUKEE AVE STE A
LIBERTYVILLE, IL
60048-1307
Practice Phone: 847-367-5575
Practice Fax: 847-367-5579
1700867694 — DR. MARTHA P ARROYO MD
Practice Location Address:
1240 N MILWAUKEE AVE STE A
LIBERTYVILLE, IL
60048-1307
Practice Phone: 847-367-5575
Practice Fax: 847-367-5579
1487802948 — KRISTEN B EISINGER PA-C
Practice Location Address:
1240 N MILWAUKEE AVE STE A
LIBERTYVILLE, IL
60048-1307
Practice Phone: 847-367-5575
Practice Fax: 847-367-5579
1174818736 — ELIZABETH ANNE SZALKO FILIPEK PA-C
Practice Location Address:
1240 N MILWAUKEE AVE STE A
LIBERTYVILLE, IL
60048-1307
Practice Phone: 847-367-5575
Practice Fax: 847-367-5579
1538690037 — DR. MALAN HASULA KERN MD
Practice Location Address:
1240 N MILWAUKEE AVE STE A
LIBERTYVILLE, IL
60048-1307
Practice Phone: 847-367-5575
Practice Fax: 847-367-5579
1932729472 — CARLA MARIE SOLOMON
Practice Location Address:
1240 N MILWAUKEE AVE STE A
LIBERTYVILLE, IL
60048-1307
Practice Phone: 847-367-5575
Practice Fax: 847-367-5579

Directions to “LAKESIDE DERMATOLOGY ” Practice Location

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