Individual
DR. VERNON TERENCE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
231 S GARY AVE, STE 114, BLOOMINGDALE, IL 60108-2234
(630) 893-8585
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036116379
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116379
—
IL
01
—
P00714795
RR MEDICARE
IL
Enumeration date
08/14/2006
Last updated
01/20/2011
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