Basic Information
| Provider Information | |||||||||
| NPI: | 1144986209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANO HEALTH ILLINOIS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9725 NW 117TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | MEDLEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331781260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545149360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6649 W ARCHER AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606382553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552266633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2021 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | MARLOW | ||||||||
| AuthorizedOfficialMiddleName: | BLAS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9545149360 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CANO HEALTH ILLINOIS, PLLC | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.