Provider Demographics
NPI:1164850483
Name:CARDENAS, MIGUEL
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6629 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3037
Mailing Address - Country:US
Mailing Address - Phone:608-831-8160
Mailing Address - Fax:
Practice Address - Street 1:6629 UNIVERSITY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3037
Practice Address - Country:US
Practice Address - Phone:608-831-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI510055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist