Kavanagh, Philip Richard

Kavanagh, Philip Richard is an individual health care provider with primary practice located at 615 N Michigan St , South Bend IN 46601-1033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Kavanagh, Philip Richard can be contacted via phone (574) 647-7459.

Contact Information

Primary practice address
615 N Michigan St South Bend IN 46601-1033
Phone: (574) 647-7459
Fax: (574) 647-3658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 02002062A Indiana

Profile Details

NPI number 1174600555
LBN Legal business name Kavanagh, Philip Richard
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2006
Last updated Feb 2nd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174600555 NPPES
Indiana MEDICAID 200252410
Indiana MEDICAID 4392339

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