Healthcare Provider Details

I. General information

NPI: 1932547643
Provider Name (Legal Business Name): JOHN CAVANAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

IV. Provider business mailing address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

V. Phone/Fax

Practice location:
  • Phone: 317-579-2130
  • Fax:
Mailing address:
  • Phone: 317-806-8260
  • Fax: 317-806-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01098058A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number269280
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: