Provider Demographics
NPI:1144778325
Name:CAGAS, COSME R (MD)
Entity Type:Individual
Prefix:DR
First Name:COSME
Middle Name:R
Last Name:CAGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:COSMELITO
Other - Middle Name:RALOTA
Other - Last Name:CAGAS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 BUHKUM WOODS DR.
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HTS.
Mailing Address - State:IL
Mailing Address - Zip Code:62208-0000
Mailing Address - Country:US
Mailing Address - Phone:618-398-6308
Mailing Address - Fax:
Practice Address - Street 1:1 BUHKUM WOODS DR.
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HTS.
Practice Address - State:IL
Practice Address - Zip Code:62208-0000
Practice Address - Country:US
Practice Address - Phone:618-398-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36052410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist