MEDICARE: MICHAEL CACKOVIC 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	207V00000X	Obstetrics & Gynecology Physician	043635	CT
2	207VM0101X	Maternal & Fetal Medicine Physician	35.099633	OH

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

General Provider Information

NPI Number	:	1962485045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CACKOVIC MD

Provider Business Mailing Address
First Line	:	395 W 12TH AVE
Second Line	:	5TH FLOOR
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-293-9269
Fax Number	:	614-293-5877

Provider Business Practice Location Address
First Line	:	1800 ZOLLINGER RD FL 4
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2800
Country	:	US
Telephone Number	:	614-293-2222
Fax Number	:	614-293-2200

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/21/2022

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Directions to “ MICHAEL CACKOVIC MD” Practice Location

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