MEDICARE: DR. MICHAEL ROBERT CAVENEE 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	2083P0901X	Public Health & General Preventive Medicine Physician	H1353	TX

General Provider Information

NPI Number	:	1619107513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ROBERT CAVENEE MD

Provider Business Mailing Address
First Line	:	5128 CORINTHIAN BAY DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4001
Country	:	US
Telephone Number	:	214-336-9410
Fax Number	:	972-758-9359

Provider Business Practice Location Address
First Line	:	5128 CORINTHIAN BAY DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4001
Country	:	US
Telephone Number	:	214-336-9410
Fax Number	:	972-758-9359

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

Provider Enumeration Date	:	07/26/2009
Last Update Date	:	07/26/2009

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