Individual
PHILLIP LEON CACIOPPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 BIESTERFIELD RD, WIMMER BLDG. SUITE 202, ELK GROVE VILLAGE, IL 60007-3311
(847) 806-0106
(847) 806-9323
Mailing address
800 BIESTERFIELD RD, WIMMER BLDG. SUITE 202, ELK GROVE VILLAGE, IL 60007-3311
(847) 806-0106
(847) 806-9323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361047981
—
IL
01
—
31602106
BLUE SHIELD
IL
01
—
461632
MEDICARE
IL
Enumeration date
02/22/2007
Last updated
12/20/2007
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