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General NPI Number Information
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NPI Number | 1033180054
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Entity Type | Organization
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Legal Business Name | CARMELITA CAEDO MD RADIOLOGY PA
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 315 W 15TH ST
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City | LIBERAL
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State | KS
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Zip | 67901-2455
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Country | US
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Telephone | 620-624-1651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2108
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City | LIBERAL
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State | KS
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Zip | 67905-2108
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Country | US
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Telephone | 316-685-6236
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Fax | 316-652-0340
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARMELITA CAEDO
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Credential | MD
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Telephone | 620-624-1651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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