# UTHMAN CAVALLO, MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093152589
- **Authorized official:** UTHMAN CAVALLO M.D. (OWNER/PRESIDENT)
- **Authorized official phone:** (574) 273-3880

## Contact information

- **Practice address:** 53800 GENERATIONS DR, SOUTH BEND, IN 46635-1543
- **Practice address phone:** (574) 273-3880
- **Practice address fax:** (574) 271-0918
- **Mailing address:** 53800 GENERATIONS DR, SOUTH BEND, IN 46635-1543
- **Mailing address phone:** (574) 273-3880
- **Mailing address fax:** (574) 271-0918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 367A00000X | Advanced Practice Midwife | — | NULL | — |
| 367A00000X | Advanced Practice Midwife | — | — | — |

## Other

- **Enumeration date:** 05/24/2013
- **Last updated:** 09/23/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201213380A | — | IN |