Healthcare Provider Details

I. General information

NPI: 1245437623
Provider Name (Legal Business Name): DOMINIQUE BERNARD CAOVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 W CREEK RD STE 35
INDEPENDENCE OH
44131-2133
US

IV. Provider business mailing address

6100 W CREEK RD STE 35
INDEPENDENCE OH
44131-2133
US

V. Phone/Fax

Practice location:
  • Phone: 216-986-4665
  • Fax:
Mailing address:
  • Phone: 216-986-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.121474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: