Provider Demographics
NPI:1306947536
Name:GARGANERA, DAN ANTHONY CABILLAGE (MD)
Entity type:Individual
Prefix:DR
First Name:DAN ANTHONY
Middle Name:CABILLAGE
Last Name:GARGANERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAN ANTHONY
Other - Middle Name:CABILLAGE
Other - Last Name:GARGANERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1051 ESSINGTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2801
Mailing Address - Country:US
Mailing Address - Phone:815-726-1818
Mailing Address - Fax:815-726-0232
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-726-1818
Practice Address - Fax:815-726-0232
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101243207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101243Medicaid
P00427864OtherRAILROAD MEDICARE
IL09900582OtherBLUE CROSS BLUE SHIELD
IL09900582OtherBLUE CROSS BLUE SHIELD
ILK45459Medicare UPIN