Provider Demographics
NPI:1942206768
Name:MCCARDEL, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MCCARDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3394 E JOLLY RD
Mailing Address - Street 2:STE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8595
Mailing Address - Country:US
Mailing Address - Phone:517-394-3200
Mailing Address - Fax:517-394-4250
Practice Address - Street 1:3394 E JOLLY RD
Practice Address - Street 2:STE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8595
Practice Address - Country:US
Practice Address - Phone:517-394-3200
Practice Address - Fax:517-394-4250
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055763207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000001131OtherPHYSICIANS HEALTH PLAN
MI0334204OtherBLUECARE NETWORK
MI2003342042OtherBLUE CROSS/BLUE SHILD
MI3515597Medicaid
MIE62018Medicare UPIN
MI2003342042OtherBLUE CROSS/BLUE SHILD