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NPI Code Detail

MEDICARE: BENNETT H MCCABE DO

MEDICARE: BENNETT H MCCABE DO
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
1207LP2900XPain Medicine (Anesthesiology) Physician113445MO
2207L00000XAnesthesiology Physician036.093019IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396731196
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENNETT H MCCABE DO
Provider Business Mailing Address
First Line : 2740 W FOSTER AVE
Second Line : STE 310
City : CHICAGO
State : IL
Zip : 60625-3500
Country : US
Telephone Number : 773-878-8200
Fax Number : 773-293-8804
Provider Business Practice Location Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number : 773-878-8200
Fax Number : 773-293-8804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 03/06/2017

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