Individual
DR. UTHMAN CAVALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
53800 GENERATIONS DR, SOUTH BEND, IN 46635
(574) 273-3880
(571) 271-0918
Mailing address
53800 GENERATIONS DR, SOUTH BEND, IN 46635-1543
(574) 273-3880
(571) 271-0918
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01054192A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
01054192A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000742843
BCBS
—
01
—
000000760931
BCBS
IN
05
—
200354000A
—
IN
Enumeration date
05/23/2006
Last updated
06/20/2018
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