Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | 40154 | CO |
Y | 2080P0214X | Pediatric Pulmonologist | 41590 | MN |
NPI | 1497830145 |
---|---|
Provider Name | Keith Cavanaugh |
First Address | Minneapolis, MN 55404-4387 |
Second Address | Minneapolis, MN 55404-4387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 02/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38376733 | (05) | CO |
H96614 | (02) | CO |