Healthcare Provider Details

I. General information

NPI: 1477520807
Provider Name (Legal Business Name): RICHARD C CARDILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-2478
US

IV. Provider business mailing address

250 W 96TH ST # 520
INDIANAPOLIS IN
46260-1316
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01046147A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number01046147A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01046147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: