Healthcare Provider Details

I. General information

NPI: 1568438851
Provider Name (Legal Business Name): DANIEL J CAVOLO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRAINARD RD
HIGHLAND HTS OH
44143-3146
US

IV. Provider business mailing address

850 BRAINARD RD
HIGHLAND HTS OH
44143-3146
US

V. Phone/Fax

Practice location:
  • Phone: 440-473-0550
  • Fax: 440-473-1266
Mailing address:
  • Phone: 440-473-0550
  • Fax: 440-473-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36001699C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: