Healthcare Provider Details

I. General information

NPI: 1093057630
Provider Name (Legal Business Name): MAGGIE A CARDONELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE A FEY M.D.

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 WINGATE COURT, STE 102
COLUMBIA MO
65201-7214
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8920
  • Fax: 573-884-4868
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2018008043
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number130882
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number2018008043
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number130882
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: