Provider Demographics
NPI:1336873546
Name:ORISEK AND MCCASKILL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ORISEK AND MCCASKILL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-871-5624
Mailing Address - Street 1:4080 CAVITT STALLMAN RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9049
Mailing Address - Country:US
Mailing Address - Phone:916-771-0715
Mailing Address - Fax:
Practice Address - Street 1:4080 CAVITT STALLMAN RD STE 100A
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-9049
Practice Address - Country:US
Practice Address - Phone:916-771-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty