Healthcare Provider Details

I. General information

NPI: 1528013372
Provider Name (Legal Business Name): UTHMAN CAVALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W JACKSON BLVD
ELKHART IN
46516-3019
US

IV. Provider business mailing address

116 W JACKSON BLVD
ELKHART IN
46516-3019
US

V. Phone/Fax

Practice location:
  • Phone: 574-273-3880
  • Fax: 571-271-0918
Mailing address:
  • Phone: 574-273-3880
  • Fax: 571-271-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01054192A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01054192A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: