Provider Demographics
NPI:1720092273
Name:CANNONIE, MICHAEL F (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:CANNONIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3323
Mailing Address - Country:US
Mailing Address - Phone:224-783-5000
Mailing Address - Fax:
Practice Address - Street 1:2000 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3323
Practice Address - Country:US
Practice Address - Phone:224-783-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC7399125OtherCONTROLLED SUBSTANCE
BC7399125OtherCONTROLLED SUBSTANCE