Provider Demographics
NPI:1649200809
Name:CARDENAS, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8122 DATAPOINT DR
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3264
Mailing Address - Country:US
Mailing Address - Phone:210-614-5113
Mailing Address - Fax:210-616-0024
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:STE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-614-5113
Practice Address - Fax:210-616-0024
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4890174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118147101Medicaid
TX834854Medicare ID - Type Unspecified
TX118147101Medicaid