Provider Demographics
NPI:1235455635
Name:MICHAEL J CAVALIERE MD PC
Entity Type:Organization
Organization Name:MICHAEL J CAVALIERE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CAVALIERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-333-2568
Mailing Address - Street 1:3363 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4285
Mailing Address - Country:US
Mailing Address - Phone:203-333-2568
Mailing Address - Fax:203-372-8923
Practice Address - Street 1:3363 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BPT
Practice Address - State:CT
Practice Address - Zip Code:06606-4285
Practice Address - Country:US
Practice Address - Phone:203-333-2568
Practice Address - Fax:203-372-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty