Healthcare Provider Details

I. General information

NPI: 1407028558
Provider Name (Legal Business Name): FREDERICK M. CAHAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST SUITE 12-260
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

201 E HURON ST SUITE 12-260
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-9570
  • Fax: 312-926-6776
Mailing address:
  • Phone: 312-926-9570
  • Fax: 312-926-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number364530
License Number StateIL

VIII. Authorized Official

Name: DR. FREDERICK M CAHAN
Title or Position: OWNER
Credential: MD
Phone: 312-926-9570