Individual
MICHELINE I CAVALLACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 DELTA WATERS RD, SUITE 107, MEDFORD, OR 97504-9114
(541) 858-2515
(541) 858-2514
Mailing address
815 N CENTRAL AVE, MEDFORD, OR 97501-5873
(541) 734-9030
(541) 734-9885
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
PA2939
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291580400
—
FL
01
—
PA175803
MEDICAL LICENSE
—
Enumeration date
12/05/2005
Last updated
03/07/2023
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