Healthcare Provider Details

I. General information

NPI: 1992386874
Provider Name (Legal Business Name): MIKE G CAWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

26 DIVISION ST
CLOSTER NJ
07624-1805
US

V. Phone/Fax

Practice location:
  • Phone: 407-300-3739
  • Fax:
Mailing address:
  • Phone: 407-300-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP109167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: