Healthcare Provider Details

I. General information

NPI: 1659370286
Provider Name (Legal Business Name): SERGIO A CARDINALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CHESTNUT ST STE 303
LOUISVILLE KY
40202-1831
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-5552
  • Fax: 502-629-3132
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31278
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number31278
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: