Provider Demographics
NPI:1912572595
Name:CAMPORROTONDO, MARIANO (MD)
Entity Type:Individual
Prefix:
First Name:MARIANO
Middle Name:
Last Name:CAMPORROTONDO
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 1:3900 KRESGE WAY STE 42
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4681
Mailing Address - Country:US
Mailing Address - Phone:502-899-3858
Mailing Address - Fax:
Practice Address - Street 1:3900 KRESGE WAY STE 42
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4681
Practice Address - Country:US
Practice Address - Phone:502-899-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55165208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty