Healthcare Provider Details

I. General information

NPI: 1205213261
Provider Name (Legal Business Name): TAMAR CACERES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W. HARRISON STREET PROFESSIONAL OFFICE BUILDING SUITE 710
CHICAGO IL
60612
US

IV. Provider business mailing address

1725 W HARRISON ST
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3034
  • Fax: 312-942-4168
Mailing address:
  • Phone: 312-942-3034
  • Fax: 312-942-4168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.156277
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036.156277
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: