Provider Demographics
NPI:1679934939
Name:STEPHANIE CAVANAUGH MD LLC
Entity Type:Organization
Organization Name:STEPHANIE CAVANAUGH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-587-6112
Mailing Address - Street 1:1210 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2148
Mailing Address - Country:US
Mailing Address - Phone:847-587-6112
Mailing Address - Fax:847-587-6113
Practice Address - Street 1:1210 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2148
Practice Address - Country:US
Practice Address - Phone:847-587-6112
Practice Address - Fax:847-587-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360419632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty