MEDICARE: DR. WINSTON P CAVERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	33037	MN

General Provider Information

NPI Number	:	1013995356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINSTON P CAVERT MD

Provider Business Mailing Address
First Line	:	6465 WAYZATA BLVD
Second Line	:	STE 315
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-1728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 DELAWARE ST SE
Second Line	:	MMC 88
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0341
Country	:	US
Telephone Number	:	612-624-9130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	05/01/2012

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