Individual
DR. ANGELA LEIGH KAVENAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3901 BEAUBIEN ER DEPT, CHILDREN'S HOSPITAL OF MI, DETROIT, MI 48201
(313) 745-5260
(313) 993-7166
Mailing address
4201 ST. ANTOINE UHC 5D, UNIVERSITY PEDIATRICIANS, DETROIT, MI 48201
(313) 966-5051
(313) 966-0665
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5101021517
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ED0251A
WEST VIRGINIA EDUCATION LICENSE
WV
01
—
UO3116
TRAINING LICENSE
FL
Enumeration date
08/15/2011
Last updated
08/07/2015
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