MEDICARE: MIDWEST POST ACUTE CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	363L00000X	Nurse Practitioner		IL

General Provider Information

NPI Number	:	1083012074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST POST ACUTE CARE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 75525
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60675-5525
Country	:	US
Telephone Number	:	888-705-8722
Fax Number	:	888-705-8722

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 803
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6185
Country	:	US
Telephone Number	:	888-705-8722
Fax Number	:	888-705-8722

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SEAN CANNONE
Credential	:	DO
Telephone Number	:	888-660-4425

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	11/26/2024

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