Provider Demographics
NPI:1508840257
Name:CAVANAUGH, CHERYL (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HEALTH PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9584
Mailing Address - Country:US
Mailing Address - Phone:303-666-2720
Mailing Address - Fax:
Practice Address - Street 1:80 HEALTH PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9584
Practice Address - Country:US
Practice Address - Phone:303-666-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12128Medicare ID - Type Unspecified
G31131Medicare UPIN