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General NPI Number Information
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NPI Number | 1497843643
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Entity Type | Individual
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Provider Name | TODD MICHAEL CORDEN P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 2450 TAMIAMI TRL STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-3922
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Country | US
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Telephone | 941-624-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117438
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601003596
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9117438
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License Number State | FL
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