Provider Demographics
NPI:1508122995
Name:ROBERT J CARDWELL MD PLLC
Entity Type:Organization
Organization Name:ROBERT J CARDWELL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-381-0410
Mailing Address - Street 1:13312 TERRY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5365
Mailing Address - Country:US
Mailing Address - Phone:586-381-0410
Mailing Address - Fax:586-754-2558
Practice Address - Street 1:13312 TERRY DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5365
Practice Address - Country:US
Practice Address - Phone:586-381-0410
Practice Address - Fax:586-754-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010714802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty