Individual
DR. CHARLES ANTHONY CAVALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3132 OLD JACKSONVILLE RD STE 110, SPRINGFIELD, IL 62704-7401
(217) 588-2600
(217) 862-0904
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-041159
IL
207Q00000X
Family Medicine Physician
258002
NY
207R00000X
Internal Medicine Physician
036041159
IL
208600000X
Surgery Physician
Primary
036041159
IL
208600000X
Surgery Physician
258002
NY
Other
Enumeration date
05/23/2007
Last updated
06/24/2020
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