Provider Demographics
NPI:1295825594
Name:CAFFERY, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:CAFFERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-9485
Mailing Address - Country:US
Mailing Address - Phone:309-449-3336
Mailing Address - Fax:309-449-6001
Practice Address - Street 1:143 FORD AVE
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747-9485
Practice Address - Country:US
Practice Address - Phone:309-449-3336
Practice Address - Fax:309-449-6001
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL28811Medicare ID - Type UnspecifiedINDIVIDUAL #
C43298Medicare UPIN
IL809860Medicare ID - Type UnspecifiedGROUP #
IL110040637 - CA4079Medicare ID - Type UnspecifiedRR