Provider Demographics
NPI:1093164972
Name:CANTON, CAITLIN
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 S. EUCLID AVENUE
Mailing Address - Street 2:MACNEAL FAMILY MEDICINE CENTER, 5TH FLOOR
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-783-2000
Mailing Address - Fax:708-783-3656
Practice Address - Street 1:3231 S. EUCLID AVENUE
Practice Address - Street 2:MACNEAL FAMILY MEDICINE CENTER, 5TH FLOOR
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-783-2000
Practice Address - Fax:708-783-3656
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125069043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program