Healthcare Provider Details

I. General information

NPI: 1659756849
Provider Name (Legal Business Name): JILLIAN ANGELO CACCAMO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN LEIGH ANGELO MD

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 305-575-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA146626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: