MEDICARE: CARDINAL PROSTHETICS & ORTHOTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	POR 54	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M2613	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1063414993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL PROSTHETICS & ORTHOTICS INC

Provider Business Mailing Address
First Line	:	13240 N CLEVELAND AVE
Second Line	:	SUITE #1
City	:	FORT MYERS
State	:	FL
Zip	:	33903-4855
Country	:	US
Telephone Number	:	239-995-4777
Fax Number	:	239-995-9777

Provider Business Practice Location Address
First Line	:	13240 N CLEVELAND AVE
Second Line	:	SUITE #1
City	:	FORT MYERS
State	:	FL
Zip	:	33903-4855
Country	:	US
Telephone Number	:	239-995-4777
Fax Number	:	239-995-9777

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. STEVEN LAWRENCE FRIES
Credential	:	LPO
Telephone Number	:	239-995-4777

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/22/2020

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Directions to “CARDINAL PROSTHETICS & ORTHOTICS INC ” Practice Location

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