MEDICARE: DR. BERTHA L CABRERA MD

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	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1235142241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERTHA L CABRERA MD

Provider Business Mailing Address
First Line	:	PO BOX 5064
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-5064
Country	:	US
Telephone Number	:	773-235-0474
Fax Number	:	847-394-2185

Provider Business Practice Location Address
First Line	:	601 W CENTRAL RD
Second Line	:	SUITE 1
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2379
Country	:	US
Telephone Number	:	773-235-0474
Fax Number	:	847-394-2185

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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