Provider Demographics
NPI:1104970417
Name:KAVANAGH, PATRICK DESMOND (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DESMOND
Last Name:KAVANAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 BO BAJURAS
Mailing Address - Street 2:VILLA MONTANA UNIT B3
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:305-354-0458
Mailing Address - Fax:
Practice Address - Street 1:1430 S DIXIE HWY STE 304
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3159
Practice Address - Country:US
Practice Address - Phone:888-696-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264898207R00000X
NJ25MA09668800207R00000X
FLME96603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-20583OtherHAWAII STATE LICENSE
PAMD462196OtherPENNSYLVANIA STATE LICENSE
GA078512OtherGEORGIA STATE LICENSE
NC2019-01534OtherNORTH CAROLINA STATE LICENSE
MT76171OtherMONTANA STATE LICENSE
VA0101264898OtherVIRGINIA STATE LICENSE
NE31765OtherNEBRASKA STATE LICENSE
SC51762OtherSOUTH CAROLINA LICENSE
CT61402OtherCONNECTICUT STATE LICENSE
IL036145182OtherILLINOIS STATE LICENSE
UT10800188OtherUTAT STATE LICENSE
TN57668OtherTENNESSEE
WI7206220OtherWISCONSON STATE LICENSE
WYTL6006OtherWYOMING STATE LICENSE
ALMD.43069OtherSTATE LICENSE
LA308192OtherLOUISIANA STATE LICENSE
KS04-41271OtherKANSAS STATE LICENSE
MI4301115326OtherMICHIGAN STATE LICENSE
WAMD60947259OtherWASHINGTON STATE LICENSE
PR022203OtherPUERTO RICO STATE LICENSE
MO2019032474OtherMISSOURI STATE LICENSE
NJ25MA09668800OtherNEW JERSEY STATE LICENSE
OH35.136642OtherOHIO STATE LICENSE
CAC154678OtherCALIFORNIA STATE LICENSE
CODR.0060459OtherCOLORADO STATE LICENSE
TXR9508OtherTEXAS STATE LICENSE