Provider Demographics
NPI:1821131509
Name:LUIS R. CACERES, D.O., P.A.
Entity Type:Organization
Organization Name:LUIS R. CACERES, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:305-271-8383
Mailing Address - Street 1:9260 SW 72ND ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3275
Mailing Address - Country:US
Mailing Address - Phone:305-271-8383
Mailing Address - Fax:305-271-8448
Practice Address - Street 1:9260 SW 72ND ST
Practice Address - Street 2:SUITE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3275
Practice Address - Country:US
Practice Address - Phone:305-271-8383
Practice Address - Fax:305-271-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528053063OtherINDIVIDUAL NPI
FLK8287Medicare ID - Type UnspecifiedMEDICARE PRACTICE ID
FL58965Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID