Provider Demographics
NPI:1578728283
Name:CARDONA, CESAR YAMIL (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:YAMIL
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 1:854 W. JAMES CAMPBELL BLVD.
Mailing Address - Street 2:STE. 101A
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-388-3209
Mailing Address - Fax:931-388-0105
Practice Address - Street 1:854 W. JAMES CAMPBELL BLVD.
Practice Address - Street 2:STE. 101A
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-388-3209
Practice Address - Fax:931-388-0105
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000046732207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522056Medicaid