Basic Information
Provider Information | |||||||||
NPI: | 1952300469 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAVALIERE | ||||||||
FirstName: | LUDWIG | ||||||||
MiddleName: | V | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 640 MARTIN LUTHER KING JR BLVD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | MACON | ||||||||
State: | GA | ||||||||
PostalCode: | 312013206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4787455455 | ||||||||
FaxNumber: | 4787452915 | ||||||||
Practice Location | |||||||||
Address1: | 640 MARTIN LUTHER KING JR BLVD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | MACON | ||||||||
State: | GA | ||||||||
PostalCode: | 312013206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4787455455 | ||||||||
FaxNumber: | 4787452915 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2005 | ||||||||
LastUpdateDate: | 02/17/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 33290 | GA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 000430911M | 05 | GA |   | MEDICAID | 110045177 | 01 |   | RAILROAD MEDICARE | OTHER | 000430911AE | 05 | GA |   | MEDICAID | 000430911AF | 05 | GA |   | MEDICAID | 000430911H | 05 | GA |   | MEDICAID | 000430911AA | 05 | GA |   | MEDICAID | 000430911AH | 05 | GA |   | MEDICAID | 000430911Z | 05 | GA |   | MEDICAID | 000430911G | 05 | GA |   | MEDICAID | 000430911Y | 05 | GA |   | MEDICAID | 000430911AD | 05 | GA |   | MEDICAID | 000430911U | 05 | GA |   | MEDICAID | 281691 | 01 |   | BLUECROSS | OTHER | 000430911N | 05 | GA |   | MEDICAID | 000430911S | 05 | GA |   | MEDICAID | 000430911AC | 05 | GA |   | MEDICAID | 000430911AG | 05 | GA |   | MEDICAID | 000430911E | 05 | GA |   | MEDICAID | 000430911L | 05 | GA |   | MEDICAID | 000430911T | 05 | GA |   | MEDICAID | 000430911V | 05 | GA |   | MEDICAID | 000430911X | 05 | GA |   | MEDICAID |