Provider Demographics
NPI:1790863116
Name:CARDONE, DONALD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:CARDONE
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 732901
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2901
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:517 N. CLYDE MORRIS BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2323
Practice Address - Country:US
Practice Address - Phone:386-425-0393
Practice Address - Fax:386-253-3484
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-11-04
Deactivation Date:2010-12-22
Deactivation Code:
Reactivation Date:2011-01-20
Provider Licenses
StateLicense IDTaxonomies
FLME31738207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37337100Medicaid
FLDS696AMedicare PIN
FL37337100Medicaid