Provider Demographics
NPI:1598814394
Name:KAVKEWITZ, MICHAEL (PH D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KAVKEWITZ
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TUXEDO CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6727 HERITAGE BUSINESS CT
Practice Address - Street 2:SUITE 724
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7015
Practice Address - Country:US
Practice Address - Phone:423-314-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA864103TC0700X
TNP001108103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0090222OtherBCBS-TN PROVIDER ID
GA00389914DMedicaid
TN3683066Medicare ID - Type Unspecified