Healthcare Provider Details

I. General information

NPI: 1588779607
Provider Name (Legal Business Name): MICHAEL K GAVIGAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL K GAVIGAN DPM

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BARLOWS LANDING RD SUITE #17
POCASSET MA
02559-1980
US

IV. Provider business mailing address

PO BOX 3227 SUITE #17
POCASSET MA
02559-3227
US

V. Phone/Fax

Practice location:
  • Phone: 508-563-7133
  • Fax: 508-563-6771
Mailing address:
  • Phone: 508-563-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1770
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: