Healthcare Provider Details

I. General information

NPI: 1811807753
Provider Name (Legal Business Name): CAICEDO MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17025 COMMERCIAL PARK RD UNIT 1
BRAINERD MN
56401-6254
US

IV. Provider business mailing address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 218-831-7642
  • Fax:
Mailing address:
  • Phone: 218-831-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL CAICEDO
Title or Position: PRESIDENT
Credential: DO
Phone: 218-831-7642