Provider Demographics
NPI:1588638639
Name:CEFALI, DOMINIC C (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:C
Last Name:CEFALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-492-5457
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4015 GATEWAY BLVD
Practice Address - Street 2:STE 2120
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-464-9133
Practice Address - Fax:812-464-0536
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01049088A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64003940Medicaid
IN200236680AMedicaid
G97694Medicare UPIN
IN532500MMMedicare PIN