Provider Demographics
NPI:1801295753
Name:CAVENDER, MARY A (DN)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N WABASH AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4704
Mailing Address - Country:US
Mailing Address - Phone:312-285-2121
Mailing Address - Fax:
Practice Address - Street 1:400 E RANDOLPH ST
Practice Address - Street 2:#1610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7329
Practice Address - Country:US
Practice Address - Phone:312-860-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000386172P00000X, 208100000X, 174400000X, 133N00000X
NM01006172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
No133N00000XDietary & Nutritional Service ProvidersNutritionist