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General NPI Number Information
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NPI Number | 1902119126
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Entity Type | Organization
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Legal Business Name | PATRICK D KAVANAGH, MD, PA
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 2301 COLLINS AVE PH 14
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City | MIAMI BEACH
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State | FL
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Zip | 33139-1601
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Country | US
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Telephone | 305-904-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 COLLINS AVE PH 14
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City | MIAMI BEACH
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State | FL
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Zip | 33139-1601
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Country | US
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Telephone | 305-904-9220
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK DESMOND KAVANAGH
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Credential | MD
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Telephone | 305-904-9220
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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 | ME96603
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License Number State | FL
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