Provider Demographics
NPI:1265729107
Name:CACIOPPO, ERICA (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CACIOPPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3664
Mailing Address - Country:US
Mailing Address - Phone:630-202-2766
Mailing Address - Fax:217-788-6459
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3757
Practice Address - Country:US
Practice Address - Phone:217-788-3156
Practice Address - Fax:217-788-6459
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.133886207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine