Provider Demographics
NPI:1871569798
Name:CAVATAIO, PIETRO A (MD, FAAFP)
Entity type:Individual
Prefix:
First Name:PIETRO
Middle Name:A
Last Name:CAVATAIO
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 ELECTRIC AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6588
Mailing Address - Country:US
Mailing Address - Phone:810-662-3220
Mailing Address - Fax:810-479-9372
Practice Address - Street 1:2603 ELECTRIC AVE STE A
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6588
Practice Address - Country:US
Practice Address - Phone:810-662-3220
Practice Address - Fax:810-479-9372
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871569798Medicaid
MIG46040037Medicare PIN
MI1871569798Medicaid