Provider Demographics
NPI:1710951561
Name:CACERES, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:CACERES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 166474
Mailing Address - Street 2:C/O INTELLIRAD IMAGING LLC
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-6474
Mailing Address - Country:US
Mailing Address - Phone:855-826-6460
Mailing Address - Fax:772-621-3184
Practice Address - Street 1:3663 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4253
Practice Address - Country:US
Practice Address - Phone:305-854-4400
Practice Address - Fax:305-285-5068
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME862162085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH61458Medicare UPIN