MEDICARE: LUCAS EDGARDO CAVALLIN MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	S6145	TX

General Provider Information

NPI Number	:	1427412055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS EDGARDO CAVALLIN MD, PHD

Provider Business Mailing Address
First Line	:	1400 N COIT RD
Second Line	:	STE 501
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6657
Country	:	US
Telephone Number	:	214-556-1222
Fax Number	:	214-556-2923

Provider Business Practice Location Address
First Line	:	1400 N COIT RD STE 501
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6657
Country	:	US
Telephone Number	:	214-556-1222
Fax Number	:	214-556-2923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2016
Last Update Date	:	06/11/2022

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