Provider Demographics
NPI:1033103320
Name:CARDONA CANCIO, MIGUEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:P
Last Name:CARDONA CANCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 PONCE DE LEON AVE.
Mailing Address - Street 2:EDIF. METROPOLIS SUITE 102
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3403
Mailing Address - Country:US
Mailing Address - Phone:787-754-0725
Mailing Address - Fax:787-622-3490
Practice Address - Street 1:419 PONCE DE LEON AVE.
Practice Address - Street 2:EDIF. METROPOLIS SUITE 102
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3403
Practice Address - Country:US
Practice Address - Phone:787-754-0725
Practice Address - Fax:787-622-3490
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11591204C00000X, 2081P2900X, 2081S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11591OtherPUERTO RICO STATE LICENCE
PRF82686Medicare UPIN
PR84469Medicare ID - Type UnspecifiedPROVIDER NUMBER