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General NPI Number Information
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NPI Number | 1437457876
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Entity Type | Individual
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Provider Name | ALEXIS CAVANAUGH M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 1000 CENTRAL ST STE 800
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City | EVANSTON
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State | IL
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Zip | 60201-1780
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Country | US
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Telephone | 847-570-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 4440 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 036138011
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License Number State | IL
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