Healthcare Provider Details

I. General information

NPI: 1730112277
Provider Name (Legal Business Name): THAD LICUANAN CUASAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPALDING DR STE 212
NAPERVILLE IL
60540-6552
US

IV. Provider business mailing address

4901 SEARLE PKWY STE 150
SKOKIE IL
60077-5320
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-7299
  • Fax: 630-961-4934
Mailing address:
  • Phone: 847-982-3363
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001916
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: