Healthcare Provider Details

I. General information

NPI: 1437176070
Provider Name (Legal Business Name): DAVID F KAVANAUGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/02/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 GRANT ST
HARVARD IL
60033-1821
US

IV. Provider business mailing address

901 GRANT ST
HARVARD IL
60033-1821
US

V. Phone/Fax

Practice location:
  • Phone: 815-943-5431
  • Fax: 815-943-5460
Mailing address:
  • Phone: 815-943-5431
  • Fax: 815-943-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number05248
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number40398-021
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-101675
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: