Healthcare Provider Details

I. General information

NPI: 1538537782
Provider Name (Legal Business Name): CHRISTOPHER S CARDWELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 N THUNDERBIRD CIR STE 303
MESA AZ
85215-1219
US

IV. Provider business mailing address

2550 N THUNDERBIRD CIR SUITE 303
MESA AZ
85215
US

V. Phone/Fax

Practice location:
  • Phone: 888-381-4858
  • Fax:
Mailing address:
  • Phone: 888-381-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6651
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: