Healthcare Provider Details

I. General information

NPI: 1902844749
Provider Name (Legal Business Name): MICHAEL F. KAVENEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13914 SOUTHEASTERN PKWY SUITE 201
FISHERS IN
46037-7127
US

IV. Provider business mailing address

13914 SOUTHEASTERN PKWY SUITE 201
FISHERS IN
46037-7127
US

V. Phone/Fax

Practice location:
  • Phone: 317-275-1999
  • Fax: 317-275-1945
Mailing address:
  • Phone: 317-275-1999
  • Fax: 317-275-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number40514
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01033579
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: