1194797266 NPI number — THOMAS L. CAO MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194797266 NPI number — THOMAS L. CAO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAO
Provider First Name:
THOMAS
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAO
Provider Other First Name:
THOMAS
Provider Other Middle Name:
LEQUN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194797266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 N RANDALL RD
Provider Second Line Business Mailing Address:
STE 135
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-7810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-717-6860
Provider Business Mailing Address Fax Number:
847-717-6872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1435 NORTH RANDALL ROAD
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-717-6860
Provider Business Practice Location Address Fax Number:
847-717-6872
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  036098274 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036098274 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04528012 . This is a "BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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