Organization
UTHMAN CAVALLO, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UTHMAN CAVALLO M.D. (OWNER/PRESIDENT)
(574) 273-3880
Entity
Organization
Contact information
Practice address
53800 GENERATIONS DR, SOUTH BEND, IN 46635-1543
(574) 273-3880
(574) 271-0918
Mailing address
53800 GENERATIONS DR, SOUTH BEND, IN 46635-1543
(574) 273-3880
(574) 271-0918
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201213380A
—
IN
Enumeration date
05/24/2013
Last updated
09/23/2016
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