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NPI Code Detail

MEDICARE: MARIELA CANO M.D.

MEDICARE: MARIELA CANO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036-091373IL

General Provider Information

NPI Number : 1053342204
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIELA CANO M.D.
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-4510
Country : US
Telephone Number : 847-390-5900
Fax Number :
Provider Business Practice Location Address
First Line : 4600 N RAVENSWOOD AVE
Second Line : 2ND FLR
City : CHICAGO
State : IL
Zip : 60640-4510
Country : US
Telephone Number : 773-561-7500
Fax Number : 773-561-7612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 06/13/2022

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Directions to “ MARIELA CANO M.D.” Practice Location

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