Provider Demographics
NPI:1659370286
Name:CARDINALI, SERGIO A (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:A
Last Name:CARDINALI
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31278207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200270810Medicaid
KY055106OtherSIHO - NICS
KY3775844OtherCIGNA - NICS
KY64312788Medicaid
KY000000626499OtherANTHEM - NICS
KY50025058OtherPASSPORT - NICS
KY000028412POtherHUMANA - NICS
KY3730045000OtherPASSPORT ADVANTAGE - NICS
KY5318655OtherAETNA - NICS
KY50025058OtherPASSPORT - NICS
KY000028412POtherHUMANA - NICS
KY3775844OtherCIGNA - NICS
KY0533164Medicare PIN