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CARDINAL DERMATOLOGY LLC
NPI 1174390926
Dermatology in South Bend, IN

Active since December 11, 2023CLIA 15D2100926 · Certificate of Compliance
4322 LAFAYETTE BLVD, SOUTH BEND, IN 46614(574) 391-1111 Get Directions Write a Review

NPPES record last updated: January 2, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 2, 2025, Dec 11, 2023 (2 updates tracked since 2023).

About Cardinal Dermatology Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CARDINAL DERMATOLOGY LLC (NPI 1174390926) is a healthcare organization registered as a dermatology in South Bend, Indiana and active in the NPI registry since December 2023. The organization holds a CLIA Certificate of Compliance certificate valid through February 16, 2028 and lists Luiz Carlos Pantalena Filho, Member, as its authorized official.

NPPES Registry Identity

NPI1174390926
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameCARDINAL DERMATOLOGY LLC
Location Address4322 LAFAYETTE BLVDSouth Bend, IN 46614
Mailing Address4322 S Lafayette BlvdSouth Bend, IN 46614-2189 · (574) 391-1111 · Fax (574) 859-5040
Phone(574) 391-1111
Organization SubpartNo
Authorized OfficialLuiz Carlos Pantalena FilhoMember · (650) 387-9765
Enumeration DateDecember 11, 2023
Last NPPES UpdateJanuary 2, 20252 updates tracked since enumeration
NPPES CertifiedDecember 31, 2024
✔ NPI 1174390926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
4322 LAFAYETTE BLVD, South Bend, IN 46614
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 15D2100926

Cardinal Dermatology, LLC · South Bend, IN
Active · expires Feb 16, 2028
CLIA Number15D2100926
Laboratory TypePhysician Office
Certificate Effective DateFebruary 17, 2026
Certificate Expiration DateFebruary 16, 2028
Laboratory DirectorLuiz C. Pantalena
Laboratory Phone(574) 391-1111
Laboratory LocationCardinal Dermatology, LLC4322 S Lafayette Blvd, South Bend, IN 46614
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Patient Reviews User submitted

Reviews are submitted by site visitors and approved by a human moderator before publication.

Review by Christpher ***** February 20, 2025

5/5
have been treated by this doctor and his staff while they were with Beacon on Ireland Rd. . Am anxious to get into his new facility for their professional and courteous treatment but am covered by VA benefits and hoping that they will get approved again by the VA..
Provider 5/5 Office Staff 5/5
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cardinal Dermatology LLC's NPI number?

The NPI number for Cardinal Dermatology LLC is 1174390926. It was assigned to this organization in the NPPES registry on December 11, 2023.

Where is Cardinal Dermatology LLC located?

Cardinal Dermatology LLC is located at 4322 Lafayette Blvd, South Bend, IN 46614. The listed phone number is (574) 391-1111.

What is Cardinal Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Cardinal Dermatology LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 15D2100926) is associated with this NPI, valid through February 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Cardinal Dermatology LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and Anthem Blue Cross and Blue Shield list Cardinal Dermatology LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Cardinal Dermatology LLC was last updated on January 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.