Organization
JAMES L CAVANAUGH JR MD & STEPHANIE VONAMMON CAVANAUGH MD SC
Active
Organization
JAMES L CAVANAUGH JR MD & STEPHANIE VONAMMON CAVANAUGH MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CAVANAUGH JR. MD (OWNER)
(312) 829-1463
Entity
Organization
Contact information
Practice address
300 S ASHLAND AVE, 207, CHICAGO, IL 60607-2701
(312) 829-1463
Mailing address
300 S ASHLAND AVE, 207, CHICAGO, IL 60607-2701
(312) 829-1463
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
036043121
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21603687
BLUE CROSS/SHIELD
IL
01
—
21603735
BLUE CROSS/SHIELD
IL
Enumeration date
08/09/2006
Last updated
09/25/2012
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