Provider Demographics
NPI:1457654840
Name:CARDINAL MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CARDINAL MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNITHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GHANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-213-1031
Mailing Address - Street 1:185 WHITESPORT DR SW STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6487
Mailing Address - Country:US
Mailing Address - Phone:256-213-1031
Mailing Address - Fax:800-765-1229
Practice Address - Street 1:185 WHITESPORT DR SW STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6487
Practice Address - Country:US
Practice Address - Phone:562-131-0312
Practice Address - Fax:800-765-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty