Provider Demographics
NPI:1053365197
Name:CAPLEA FAMILY MEDICINE
Entity type:Organization
Organization Name:CAPLEA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:O
Authorized Official - Last Name:CAPLEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-647-9800
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0699
Mailing Address - Country:US
Mailing Address - Phone:708-647-9800
Mailing Address - Fax:708-647-9814
Practice Address - Street 1:19624 GOVERNORS HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2077
Practice Address - Country:US
Practice Address - Phone:708-647-9800
Practice Address - Fax:708-647-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106422Medicaid
IL036106422Medicaid
IL036106422Medicaid