Provider Demographics
NPI:1205213261
Name:CACERES, TAMAR (MD)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:CACERES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W. HARRISON STREET
Mailing Address - Street 2:PROFESSIONAL OFFICE BUILDING SUITE 710
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-3034
Mailing Address - Fax:312-942-4168
Practice Address - Street 1:1725 W. HARRISON STREET
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING SUITE 710
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-3034
Practice Address - Fax:312-942-4168
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC7-0005910208000000X
IL036.1562772084P0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics