Healthcare Provider Details

I. General information

NPI: 1396795258
Provider Name (Legal Business Name): RICHARD E KARDON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE UM MILLER SCHOOL OF MEDICINE, JMH NORTH WING 109 (R-76)
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE UM MILLER SCHOOL OF MEDICINE, JMH NORTH WING 109 (R-76)
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6683
  • Fax:
Mailing address:
  • Phone: 305-585-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberOS010552L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMB 70340
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberOS 10209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: