Provider Demographics
NPI:1023788460
Name:CAHAK, ROGER MICHAEL
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:MICHAEL
Last Name:CAHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 N ALBANY AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2405
Mailing Address - Country:US
Mailing Address - Phone:315-715-5572
Mailing Address - Fax:
Practice Address - Street 1:2329 N LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2309
Practice Address - Country:US
Practice Address - Phone:773-234-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program