Provider Demographics
NPI:1578763009
Name:KARDYS, CLARK MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:MICHAEL
Last Name:KARDYS
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 1:7950 FLOYD CURL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3919
Mailing Address - Country:US
Mailing Address - Phone:210-614-0880
Mailing Address - Fax:210-615-0258
Practice Address - Street 1:7950 FLOYD CURL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-0880
Practice Address - Fax:210-615-0258
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN9574208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287673202Medicaid