Provider Demographics
NPI:1811062300
Name:CUMBA, CESARIO MONSANTO (MD)
Entity type:Individual
Prefix:DR
First Name:CESARIO
Middle Name:MONSANTO
Last Name:CUMBA
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 1:219 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1442
Mailing Address - Country:US
Mailing Address - Phone:815-942-3000
Mailing Address - Fax:815-942-2333
Practice Address - Street 1:219 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1442
Practice Address - Country:US
Practice Address - Phone:815-942-3000
Practice Address - Fax:815-942-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03649033207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC-38400Medicare UPIN
IL259480Medicare ID - Type Unspecified