Provider Demographics
NPI:1598873473
Name:CANNESTRA, VINCENT P (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:P
Last Name:CANNESTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-9072
Practice Address - Street 1:2350 ROYAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4719
Practice Address - Country:US
Practice Address - Phone:847-931-5300
Practice Address - Fax:847-931-9072
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093781207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093781Medicaid
200036791OtherRR MEDICARE PROV ID
CG2631OtherRR MEDICARE MCHENRY
208821OtherMEDICARE GRP KANE
207906OtherMEDICARE GRP MCHENRY
CE6001OtherRR MEDICARE GRP KANE
CE6001OtherRR MEDICARE GRP KANE
IL0354460001Medicare NSC
G89581Medicare UPIN
IL0354460005Medicare NSC
CG2631OtherRR MEDICARE MCHENRY
200036791OtherRR MEDICARE PROV ID
ILK02713Medicare ID - Type UnspecifiedMCHENRY COUNTY
IL0354460003Medicare NSC