Provider Demographics
NPI:1124063987
Name:MICHAEL D. CASHMAN, M.D., S.C.
Entity type:Organization
Organization Name:MICHAEL D. CASHMAN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-671-8313
Mailing Address - Street 1:108 SW MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1107
Mailing Address - Country:US
Mailing Address - Phone:309-671-8749
Mailing Address - Fax:309-671-8740
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 490
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-671-8313
Practice Address - Fax:309-671-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208846Medicare ID - Type UnspecifiedMEDICARE
ILC37679Medicare UPIN