Provider Demographics
NPI:1376500736
Name:SARDON, DANNY C (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:C
Last Name:SARDON
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 1:1507 WABASH ST
Mailing Address - Street 2:SUITE 500 B
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4300
Mailing Address - Country:US
Mailing Address - Phone:219-872-7555
Mailing Address - Fax:855-774-1402
Practice Address - Street 1:1507 WABASH ST
Practice Address - Street 2:SUITE 400B
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4300
Practice Address - Country:US
Practice Address - Phone:219-872-7555
Practice Address - Fax:855-774-1402
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032287C208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000079474OtherBCBS PIN NUMBER
IN100163860AMedicaid
IL91115450OtherBCBS IL PIN
IN485940AMedicare PIN
IN100163860AMedicaid
IL91115450OtherBCBS IL PIN
INB2-9051Medicare UPIN
IN487160KMedicare PIN