Provider Demographics
NPI:1619021300
Name:CARDINAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CARDINAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-889-0557
Mailing Address - Street 1:1401 E 4TH AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3504
Mailing Address - Country:US
Mailing Address - Phone:305-889-0557
Mailing Address - Fax:305-889-5989
Practice Address - Street 1:1401 E 4TH AVE
Practice Address - Street 2:STE 103
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3504
Practice Address - Country:US
Practice Address - Phone:305-889-0557
Practice Address - Fax:305-889-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104565Medicare ID - Type UnspecifiedPROVIDER NUMBER