Healthcare Provider Details

I. General information

NPI: 1093069635
Provider Name (Legal Business Name): CARDINAL HOME PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27780 NOVI RD 102
NOVI MI
48377-3401
US

IV. Provider business mailing address

23611 LONG POINT WAY 808
NOVI MI
48375-3278
US

V. Phone/Fax

Practice location:
  • Phone: 877-221-1716
  • Fax: 877-221-1716
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMON MADRID
Title or Position: CO-OWNER
Credential: MD
Phone: 877-221-1716