Individual
JEAN ANN CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2650 RIDGE AVE, DEPARTMENT OF PHYS MED SUITE 2204, EVANSTON, IL 60201-1718
(847) 570-2066
(847) 570-2901
Mailing address
2650 RIDGE AVE, EVANSTON HOSPITAL, EVANSTON, IL 60201-1718
(847) 570-1206
(847) 570-1248
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1620385
BCBS PPO
IL
Enumeration date
07/16/2006
Last updated
11/27/2007
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