MEDICARE: COSME R CAGAS, MD

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
1	174400000X	Specialist	036052410	IL

General Provider Information

NPI Number	:	1124478920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSME R CAGAS, MD

Provider Business Mailing Address
First Line	:	1 BUNKUM WOODS DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1008
Country	:	US
Telephone Number	:	618-398-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BUNKUM WOODS DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1008
Country	:	US
Telephone Number	:	618-398-6308
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. COSME RALOTA CAGAS II
Credential	:	MD
Telephone Number	:	618-398-6308

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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