Provider Demographics
NPI:1437176070
Name:KAVANAUGH, DAVID F (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-1821
Mailing Address - Country:US
Mailing Address - Phone:815-943-5431
Mailing Address - Fax:815-943-5460
Practice Address - Street 1:901 GRANT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-1821
Practice Address - Country:US
Practice Address - Phone:815-943-5431
Practice Address - Fax:815-943-5460
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05248207P00000X
WI40398-021207P00000X
IL036-101675207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00448088CG6042OtherRR MEDICARE
WI1437176070Medicaid
IL$$$$$$$$$Medicaid
IL080142264CD3624OtherRR MEDICARE
ILK02718Medicare PIN
ILK08842Medicare PIN
ILL76087214660Medicare PIN
WI016654176Medicare PIN
WI1437176070Medicaid
IL$$$$$$$$$ 2Medicaid