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General NPI Number Information
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NPI Number | 1679525836
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Entity Type | Individual
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Provider Name | MICHAEL JOHN CAVANAUGH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 11211 SW 152ND ST
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City | MIAMI
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State | FL
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Zip | 33157-1101
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Country | US
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Telephone | 305-255-1355
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Fax | 305-255-2015
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Provider Business Mailing Address
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Address Line | 11211 SW 152ND ST
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City | MIAMI
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State | FL
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Zip | 33157-1101
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Country | US
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Telephone | 305-255-1355
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Fax | 305-278-2670
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME39723
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License Number State | FL
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