Healthcare Provider Details

I. General information

NPI: 1144763582
Provider Name (Legal Business Name): MICHAEL JOHN CAHANDING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 MIDDLEBURY DR
AURORA IL
60503-5435
US

IV. Provider business mailing address

2138 MIDDLEBURY DR
AURORA IL
60503-5435
US

V. Phone/Fax

Practice location:
  • Phone: 630-639-7367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041380822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: