Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Cardinal Dermatology LLC

Organization Dermatology Physician · NPI 1174390926

Cardinal Dermatology LLC is a Dermatology Physician in South Bend, Indiana. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4322 Lafayette Blvd
South Bend, IN 46614
Phone: (574) 391-1111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X
MOHS-Micrographic Surgery Physician Taxonomy 207ND0101X
Procedural Dermatology Physician Taxonomy 207NS0135X

Record details

NPI number1174390926
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Luiz Pantalena Filho — Member · (650) 387-9765
NPI enumeratedDecember 11, 2023
Last updated in NPPESJanuary 2, 2025
Certification dateDecember 31, 2024
Mailing address4322 S Lafayette Blvd, South Bend, IN 46614-2189

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