Healthcare Provider Details

I. General information

NPI: 1598873473
Provider Name (Legal Business Name): VINCENT P CANNESTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ROYAL BLVD SUITE 200
ELGIN IL
60123-4719
US

IV. Provider business mailing address

2350 ROYAL BLVD SUITE 200
ELGIN IL
60123-4719
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-5300
  • Fax: 847-931-9072
Mailing address:
  • Phone: 847-931-5300
  • Fax: 847-931-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036093781
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036093781
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: