Provider Demographics
NPI:1306865910
Name:CARDELLIO, ANTHONY LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LOUIS
Last Name:CARDELLIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6483 CITATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2994
Mailing Address - Country:US
Mailing Address - Phone:248-861-0010
Mailing Address - Fax:248-861-0020
Practice Address - Street 1:50505 SCHOENHERR RD STE 230
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-803-3484
Practice Address - Fax:586-803-3354
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4501513Medicaid
1962158303OtherGROUP NPI
MI4501513Medicaid