# DR. VINCENT P CANNESTRA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1598873473
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036093781 | IL | Yes |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | 036093781 | IL | — |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 12/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036093781 | — | IL |
| 01 | — | 200036791 | RR MEDICARE PROV ID | — |
| 01 | — | 207906 | MEDICARE GRP MCHENRY | — |
| 01 | — | 208821 | MEDICARE GRP KANE | — |
| 01 | — | CE6001 | RR MEDICARE GRP KANE | — |
| 01 | — | CG2631 | RR MEDICARE MCHENRY | — |