MEDICARE: DR. 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	36052410	IL

General Provider Information

NPI Number	:	1144778325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COSME R. CAGAS MD

Provider Business Mailing Address
First Line	:	1 BUHKUM WOODS DR.
Second Line	:
City	:	FAIRVIEW HTS.
State	:	IL
Zip	:	62208-0000
Country	:	US
Telephone Number	:	618-398-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BUHKUM WOODS DR.
Second Line	:
City	:	FAIRVIEW HTS.
State	:	IL
Zip	:	62208-0000
Country	:	US
Telephone Number	:	618-398-6308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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