MEDICARE: ANTONIO T. CACERES 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	208000000X	Pediatrics Physician	68212-20	WI
2	208000000X	Pediatrics Physician	036096583	IL

General Provider Information

NPI Number	:	1780692525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO T. CACERES MD

Provider Business Mailing Address
First Line	:	472 BRIARGATE DR STE 107
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2225
Country	:	US
Telephone Number	:	630-315-1600
Fax Number	:	630-315-1683

Provider Business Practice Location Address
First Line	:	472 BRIARGATE DR STE 107
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2225
Country	:	US
Telephone Number	:	630-315-1600
Fax Number	:	630-315-1683

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/15/2023

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Directions to “ ANTONIO T. CACERES MD” Practice Location

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