Provider Demographics
NPI:1275614612
Name:KAVANAGH, JOSEPH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:KAVANAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 COLLINS AVE
Mailing Address - Street 2:APT 404
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4722
Mailing Address - Country:US
Mailing Address - Phone:305-331-9580
Mailing Address - Fax:
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:#104
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:305-331-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25044282N00000X
FL4141642085R0202X
VT042-00112912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No282N00000XHospitalsGeneral Acute Care Hospital