MEDICARE: DR. GEOFFREY O CAPLEA 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	207Q00000X	Family Medicine Physician	036106422	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-3954071	OTHER	IL	TAX ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306845011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY O CAPLEA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 699
Second Line	:
City	:	MATTESON
State	:	IL
Zip	:	60443-0699
Country	:	US
Telephone Number	:	708-647-9800
Fax Number	:	708-647-9814

Provider Business Practice Location Address
First Line	:	19624 GOVERNORS HWY
Second Line	:	SUITE 9
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2077
Country	:	US
Telephone Number	:	708-647-9800
Fax Number	:	708-647-9814

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	05/09/2008

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