Provider Demographics
NPI:1831274489
Name:GERALD A CAHILL MD SC
Entity type:Organization
Organization Name:GERALD A CAHILL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-5658
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-422-5658
Mailing Address - Fax:708-422-4660
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-422-5658
Practice Address - Fax:708-422-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16754Medicare UPIN
IL789830Medicare ID - Type Unspecified