=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821008996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH MICHAEL CARDAMONE JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 11/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11850 BLACKFOOT NE SUITE 100
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55433-2598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-712-2100
-----------------------------------------------------
Fax | 763-712-2190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 UNIVERSITY AVE W STE 110N
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55114-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-602-5309
-----------------------------------------------------
Fax | 651-222-6786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 19858
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------