Provider Demographics
NPI:1538151642
Name:CACERES, MAURICIO H (MD)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:H
Last Name:CACERES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2309
Mailing Address - Country:US
Mailing Address - Phone:513-561-7809
Mailing Address - Fax:513-272-4121
Practice Address - Street 1:11140 MONTGOMERY RD STE 2500
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-561-7809
Practice Address - Fax:513-272-4121
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063946C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125135Medicaid
OH4149412Medicare PIN
OH0125135Medicaid
OHF59327Medicare UPIN