MEDICARE: BERTHA 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	2080A0000X	Pediatric Adolescent Medicine Physician	036065550	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036065550	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841465390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERTHA CABRERA MD

Provider Business Mailing Address
First Line	:	601 W CENTRAL RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2379
Country	:	US
Telephone Number	:	815-463-8994
Fax Number	:	815-463-8946

Provider Business Practice Location Address
First Line	:	601 W CENTRAL RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2379
Country	:	US
Telephone Number	:	815-463-8994
Fax Number	:	815-463-8946

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BERTHA CABRERA
Credential	:	M.D.
Telephone Number	:	816-463-8994

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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Directions to “BERTHA CABRERA MD ” Practice Location

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