Provider Demographics
NPI:1245437623
Name:CAOVAN, DOMINIQUE BERNARD (MD)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:BERNARD
Last Name:CAOVAN
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 1:6100 W CREEK RD STE 35
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2133
Mailing Address - Country:US
Mailing Address - Phone:216-986-4665
Mailing Address - Fax:
Practice Address - Street 1:6100 W CREEK RD STE 35
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2133
Practice Address - Country:US
Practice Address - Phone:216-986-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1214742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology