MEDICARE: MARCO SARDELA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Y00000X	Clinical Exercise Physiologist

General Provider Information

NPI Number	:	1184300337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO SARDELA

Provider Business Mailing Address
First Line	:	5818 N PENNSYLVANIA AVE APT 210B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7489
Country	:	US
Telephone Number	:	217-419-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	5818 N PENNSYLVANIA AVE APT 210B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7489
Country	:	US
Telephone Number	:	217-419-5673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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Directions to “ MARCO SARDELA ” Practice Location

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