Provider Demographics
NPI:1568438851
Name:CAVOLO, DANIEL J (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:CAVOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BRAINARD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3146
Mailing Address - Country:US
Mailing Address - Phone:440-473-0550
Mailing Address - Fax:440-473-1266
Practice Address - Street 1:850 BRAINARD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3146
Practice Address - Country:US
Practice Address - Phone:440-473-0550
Practice Address - Fax:440-473-1266
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001699C213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341582432007OtherMEDICAL MUTUAL
OH000000134635OtherANTHEM PIN
OH000000166644OtherANTHEM GROUP
OH0305959Medicaid
OH341582432007OtherMEDICAL MUTUAL
OH000000166644OtherANTHEM GROUP