Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01080104A | IN |
N | 208600000X | Surgeon | 01080104A | IN |
N | 208200000X | Surgeon | MD428571 | PA |
N | 208600000X | Surgeon | MD428571 | PA |
Y | 2086X0206X | Surgical Oncologist | 01080104A | IN |
NPI | 1275799140 |
---|---|
Provider Name | Dr. Jon S Cardinal |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46250-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300013128 | (05) | IN |