Healthcare Provider Details

I. General information

NPI: 1023788460
Provider Name (Legal Business Name): ROGER MICHAEL CAHAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 N LAWNDALE AVE
CHICAGO IL
60647-2309
US

IV. Provider business mailing address

6110 N ALBANY AVE UNIT 1
CHICAGO IL
60659-2405
US

V. Phone/Fax

Practice location:
  • Phone: 773-234-1463
  • Fax:
Mailing address:
  • Phone: 315-715-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: