MEDICARE: TAMAR CACERES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	C7-0005910	DE
3	2084P0005X	Neurodevelopmental Disabilities Physician	036.156277	IL

General Provider Information

NPI Number	:	1205213261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMAR CACERES M.D.

Provider Business Mailing Address
First Line	:	1725 W. HARRISON STREET
Second Line	:	PROFESSIONAL OFFICE BUILDING SUITE 710
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:	312-942-4168

Provider Business Practice Location Address
First Line	:	1725 W. HARRISON STREET
Second Line	:	PROFESSIONAL OFFICE BUILDING SUITE 710
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:	312-942-4168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	05/12/2021

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