Provider Demographics
NPI:1063816361
Name:MICHELLE L CARDIN
Entity Type:Organization
Organization Name:MICHELLE L CARDIN
Other - Org Name:WILDHORSE PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-721-1473
Mailing Address - Street 1:22299 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940-3100
Mailing Address - Country:US
Mailing Address - Phone:918-721-1473
Mailing Address - Fax:
Practice Address - Street 1:3807 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2452
Practice Address - Country:US
Practice Address - Phone:918-721-1473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27462208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty