Individual
MICHAEL K CAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1802 YAKIMA AVE STE 102, TACOMA, WA 98405-5303
(253) 272-7777
Mailing address
1802 YAKIMA AVE STE 102, TACOMA, WA 98405-5303
(253) 272-7777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003792
WA
363AS0400X
Surgical Physician Assistant
PA10003792
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0127008
STATE L&I
WA
05
—
1045595
—
WA
05
—
8403339
—
WA
01
—
8926049
CRIME VICTIMS
WA
01
—
P00220038
MEDICARE RAILROAD
WA
Enumeration date
06/21/2006
Last updated
12/02/2020
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