MEDICARE: DR. UTHMAN CAVALLO M.D.

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	207V00000X	Obstetrics & Gynecology Physician	01054192A	IN
2	174400000X	Specialist	01054192A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000742843	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000760931	OTHER	IN	BCBS

General Provider Information

NPI Number	:	1528013372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UTHMAN CAVALLO M.D.

Provider Business Mailing Address
First Line	:	116 W JACKSON BLVD
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3019
Country	:	US
Telephone Number	:	574-273-3880
Fax Number	:	571-271-0918

Provider Business Practice Location Address
First Line	:	116 W JACKSON BLVD
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3019
Country	:	US
Telephone Number	:	574-273-3880
Fax Number	:	571-271-0918

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/01/2026

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