MEDICARE: DR. DOMINIC C CEFALI MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	01049088A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588638639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC C CEFALI MD

Provider Business Mailing Address
First Line	:	PO BOX 1230
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47706-1230
Country	:	US
Telephone Number	:	812-492-5457
Fax Number	:	812-464-4485

Provider Business Practice Location Address
First Line	:	4015 GATEWAY BLVD
Second Line	:	STE 2120
City	:	NEWBURGH
State	:	IN
Zip	:	47630
Country	:	US
Telephone Number	:	812-464-9133
Fax Number	:	812-464-0536

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/03/2018

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