Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 5101005761 | MI |
NPI | 1053344994 |
---|---|
Provider Name | Dr. Anthony Cardellio |
First Address | Warren, MI 48093-6505 |
Second Address | Warren, MI 48093-6505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 30/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053344994 | NPI (01) | MI |
1073542742 | NPI (01) | MI |
E25476 | (02) | MI |