Provider Demographics
NPI:1902844749
Name:KAVENEY, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:KAVENEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13914 SOUTHEASTERN PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7127
Mailing Address - Country:US
Mailing Address - Phone:317-275-1999
Mailing Address - Fax:317-275-1945
Practice Address - Street 1:13914 SOUTHEASTERN PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7127
Practice Address - Country:US
Practice Address - Phone:317-275-1999
Practice Address - Fax:317-275-1945
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40514207XX0005X
IN01033579207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4389953OtherAETNA PIN
IN100088590Medicaid
IN000000093732OtherANTHEM PIN
AZ701446Medicaid
ININ2137001Medicare PIN
IN4389953OtherAETNA PIN
AZZ154318Medicare PIN