MEDICARE: DANIEL J CAVOLO D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36001699C	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341582432007	OTHER	OH	MEDICAL MUTUAL
2	000000134635	OTHER	OH	ANTHEM PIN
3	000000166644	OTHER	OH	ANTHEM GROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568438851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J CAVOLO D.P.M.

Provider Business Mailing Address
First Line	:	850 BRAINARD RD
Second Line	:
City	:	HIGHLAND HTS
State	:	OH
Zip	:	44143-3146
Country	:	US
Telephone Number	:	440-473-0550
Fax Number	:	440-473-1266

Provider Business Practice Location Address
First Line	:	850 BRAINARD RD
Second Line	:
City	:	HIGHLAND HTS
State	:	OH
Zip	:	44143-3146
Country	:	US
Telephone Number	:	440-473-0550
Fax Number	:	440-473-1266

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	03/04/2013

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