MEDICARE: CAILIAN MO

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
1	363LF0000X	Family Nurse Practitioner	209015537	IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277001664	IL
3	163WE0003X	Emergency Registered Nurse	041411039	IL

General Provider Information

NPI Number	:	1285172643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAILIAN MO

Provider Business Mailing Address
First Line	:	3834 S HERMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-2006
Country	:	US
Telephone Number	:	773-470-3735
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-470-3735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	03/23/2026

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Directions to “ CAILIAN MO ” Practice Location

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