Provider Demographics
NPI:1295735538
Name:CAWDERY, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:CAWDERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 N FRESNO ST
Mailing Address - Street 2:UCSF-FRESNO DEPT OF EMERGENCY MEDICINE
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2302
Mailing Address - Country:US
Mailing Address - Phone:559-499-6440
Mailing Address - Fax:559-499-6441
Practice Address - Street 1:155 N FRESNO ST
Practice Address - Street 2:UCSF-FRESNO DEPT OF EMERGENCY MEDICINE
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2302
Practice Address - Country:US
Practice Address - Phone:559-499-6440
Practice Address - Fax:559-499-6441
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA77280207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A772800Medicaid
CA00A772800Medicaid
CA00A772803Medicare PIN