Healthcare Provider Details

I. General information

NPI: 1861478141
Provider Name (Legal Business Name): WILLIE CACHO M.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CG-1122 USCG CMDT 2100 2ND ST., SW, SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

100 MACARTHUR CSWY
MIAMI BEACH FL
33139-5101
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-4535
  • Fax: 305-535-4413
Mailing address:
  • Phone: 305-535-4535
  • Fax: 305-535-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08009
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39402
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: