Healthcare Provider Details

I. General information

NPI: 1548443930
Provider Name (Legal Business Name): THERESA CAO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 11/27/2023
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N FLORIDA AVE
LAKELAND FL
33805-3109
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3019
US

V. Phone/Fax

Practice location:
  • Phone: 863-904-6200
  • Fax: 866-264-8519
Mailing address:
  • Phone: 863-680-7000
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberOS10250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: