Kavanaugh, John W

Kavanaugh, John W is an individual health care provider with primary practice located at 451 Health Pkwy Suite E, Paw Paw MI 49079-8242. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Kavanaugh, John W can be contacted via phone (269) 655-3090.

Contact Information

Primary practice address
451 Health Pkwy Suite E Paw Paw MI 49079-8242
Phone: (269) 655-3090
Fax: (269) 655-0763
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301405215 Michigan

Profile Details

NPI number 1609858844
LBN Legal business name Kavanaugh, John W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2005
Last updated Oct 16th, 2014 - about 11 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 1609858844 NPPES
Michigan MEDICAID 4938480
Michigan Other 238601

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