Provider Demographics
NPI:1770544462
Name:CASSIDY, EMMET MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:EMMET
Middle Name:MICHAEL
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18646 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3715
Mailing Address - Country:US
Mailing Address - Phone:708-647-6635
Mailing Address - Fax:
Practice Address - Street 1:18646 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3715
Practice Address - Country:US
Practice Address - Phone:708-647-6635
Practice Address - Fax:708-647-6649
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092971207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620861OtherBLUE CROSS AND BLUE SHIELD
IL205785OtherPTAN IL MEDICARE COOK COUNTY
IL036092971Medicaid
IL180046212OtherMEDICARE RAILROAD
IL1083684922OtherTHE ESC GROUP NPI
ILP00379235OtherMEDICARE RAILROAD
IL036092971Medicaid
IL6180260001Medicare NSC
ILK48576Medicare PIN
IL01620861OtherBLUE CROSS AND BLUE SHIELD
K32053Medicare PIN