Provider Demographics
NPI:1285760207
Name:CAVELL, JOHN L (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:CAVELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30730 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1803
Mailing Address - Country:US
Mailing Address - Phone:734-421-7474
Mailing Address - Fax:734-421-0961
Practice Address - Street 1:30730 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1803
Practice Address - Country:US
Practice Address - Phone:734-421-7474
Practice Address - Fax:734-421-0961
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80786Medicare UPIN
MI0Q26334065Medicare PIN