Provider Demographics
NPI:1083372924
Name:CAULO, MICHAEL (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CAULO
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WOODTHORN RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-4511
Mailing Address - Country:US
Mailing Address - Phone:163-174-1995
Mailing Address - Fax:
Practice Address - Street 1:21 WOODTHORN RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-4511
Practice Address - Country:US
Practice Address - Phone:163-174-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-3527446