Provider Demographics
NPI:1588841605
Name:VICTOR W. CACERES, M.D.,S.C.
Entity Type:Organization
Organization Name:VICTOR W. CACERES, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-885-9238
Mailing Address - Street 1:919 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3001
Mailing Address - Country:US
Mailing Address - Phone:920-885-9238
Mailing Address - Fax:920-885-4405
Practice Address - Street 1:919 S. UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3001
Practice Address - Country:US
Practice Address - Phone:920-885-9238
Practice Address - Fax:920-885-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20274261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB51909Medicare UPIN