Provider Demographics
NPI:1174016935
Name:CARDONA, ALVIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:F
Last Name:CARDONA
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:W126N7338 FLINT DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4532
Mailing Address - Country:US
Mailing Address - Phone:414-777-3754
Mailing Address - Fax:
Practice Address - Street 1:W168N11237 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3239
Practice Address - Country:US
Practice Address - Phone:262-253-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165502207Q00000X
WI21041-875207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program