Provider Demographics
NPI:1093763690
Name:CARDENAS, OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:CARDENAS
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 1:2101 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3716
Mailing Address - Country:US
Mailing Address - Phone:813-501-7407
Mailing Address - Fax:813-964-3113
Practice Address - Street 1:2101 CURRY ROAD LUTZ
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-3716
Practice Address - Country:US
Practice Address - Phone:813-901-2704
Practice Address - Fax:813-964-3113
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076006207R00000X
FLME76006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271735201Medicaid
FLG62196Medicare UPIN
FL271735201Medicaid