Individual
DR. VINCENT P CANNESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2350 ROYAL BLVD, SUITE 200, ELGIN, IL 60123-4719
(847) 931-5300
(847) 931-9072
Mailing address
2350 ROYAL BLVD, SUITE 200, ELGIN, IL 60123-4719
(847) 931-5300
(847) 931-9072
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036093781
IL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
036093781
IL
Other
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
—
Enumeration date
08/29/2006
Last updated
12/17/2021
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