Provider Demographics
NPI:1427412055
Name:CAVALLIN, LUCAS EDGARDO (MD, PHD)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:EDGARDO
Last Name:CAVALLIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N COIT RD
Mailing Address - Street 2:STE 501
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6657
Mailing Address - Country:US
Mailing Address - Phone:214-556-1222
Mailing Address - Fax:214-556-2923
Practice Address - Street 1:1400 N COIT RD STE 501
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6657
Practice Address - Country:US
Practice Address - Phone:214-556-1222
Practice Address - Fax:214-556-2923
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6145207N00000X
PAMT213446390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program