Individual
MICHAEL H CACCAVALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
121 SOTOYOME ST, SANTA ROSA, CA 95405-4823
(707) 546-4062
(707) 525-4095
Mailing address
PO BOX 5651, ORANGE, CA 92863-5651
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
49942
MN
2085R0202X
Diagnostic Radiology Physician
A121222
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
A121222
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
572447100
—
MN
Enumeration date
07/03/2007
Last updated
05/19/2014
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