Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 27940 | WI |
N | 208600000X | Surgeon | 27940 | WI |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 27940 | WI |
NPI | 1104912153 |
---|---|
Provider Name | Daniel G Cavanaugh |
First Address | Mondovi, WI 54755-8886 |
Second Address | Mondovi, WI 54755-8886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 23/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30763200 | (05) | WI |
B51992 | (02) |