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NPI Code Detail

MEDICARE: MICHAEL J CAVANAUGH

MEDICARE: MICHAEL J CAVANAUGH
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
1363A00000XPhysician AssistantPA.0004654CO
2363A00000XPhysician Assistant11810MN

General Provider Information

NPI Number : 1912396144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J CAVANAUGH
Provider Business Mailing Address
First Line : PO BOX 649
Second Line :
City : FORT DEFIANCE
State : AZ
Zip : 86504-0649
Country : US
Telephone Number : 928-729-8000
Fax Number :
Provider Business Practice Location Address
First Line : CORNER OF ROUTE N12 AND N7
Second Line :
City : FORT DEFIANCE
State : AZ
Zip : 86504
Country : US
Telephone Number : 928-729-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2015
Last Update Date : 03/20/2026

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