Provider Demographics
NPI:1508009192
Name:CACCO, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CACCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BARCLAY CIR
Mailing Address - Street 2:STE D
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5802
Mailing Address - Country:US
Mailing Address - Phone:248-852-5355
Mailing Address - Fax:248-852-8411
Practice Address - Street 1:595 BARCLAY CIR
Practice Address - Street 2:STE D
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5802
Practice Address - Country:US
Practice Address - Phone:248-852-5355
Practice Address - Fax:248-852-8411
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315053445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine