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General NPI Number Information
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NPI Number | 1548213879
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Entity Type | Individual
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Provider Name | MICHAEL C CAVALLARO MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 1600 PHILLIPS RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5304
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Country | US
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Telephone | 850-878-4127
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Fax | 850-878-0337
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Provider Business Mailing Address
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Address Line | PO BOX 1678
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City | TALLAHASSEE
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State | FL
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Zip | 32302-1678
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Country | US
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Telephone | 850-878-4102
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Fax | 850-942-4155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | ME54263
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME54263
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License Number State | FL
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