Organization
PHILLIP L CACIOPPO MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP L CACIOPPO MD (PRESIDENT)
(847) 806-0106
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360417401
—
IL
01
—
31602106
BLUE SHIELD
IL
Enumeration date
02/22/2007
Last updated
10/29/2012
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