Provider Demographics
NPI:1093714321
Name:CARDINAL, MICHAEL DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:CARDINAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 FORD ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1947
Mailing Address - Country:US
Mailing Address - Phone:419-893-5539
Mailing Address - Fax:419-893-6853
Practice Address - Street 1:609 FORD ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1947
Practice Address - Country:US
Practice Address - Phone:419-893-5539
Practice Address - Fax:419-893-6853
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002393213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00322OtherPARAMOUNT
OH0696733Medicaid
OH000000135416OtherANTHEM
OH0696733Medicaid
OH480008103Medicare PIN
OH480014323Medicare PIN
OH00322OtherPARAMOUNT
OH0537250002Medicare NSC
T80647Medicare UPIN
OHCA0614114Medicare PIN