Provider Demographics
NPI:1073561536
Name:KARDINAL, CARL G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:KARDINAL
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:115 BUSINESS LOOP 70 W
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3244
Practice Address - Country:US
Practice Address - Phone:573-882-4979
Practice Address - Fax:573-884-6050
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.05111R207RH0003X
MO30252207RH0003X
CODR-52800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1305481Medicaid
B61613Medicare UPIN
MO152360001Medicare PIN
LA5M066Medicare ID - Type Unspecified