Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 071480 | MI |
NPI | 1003805318 |
---|---|
Provider Name | Robert J Cardwell |
First Address | Roseville, MI 48066-4975 |
Second Address | Roseville, MI 48066-4975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 20/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3423898 | (05) | MI |
3423904 | (05) | MI |
4714890 | (05) | MI |
CD7957 | RAILROAD MEDICARE (01) | MI |
CD7959 | RAILROAD MEDICARE (01) | MI |
E61458 | (02) |