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NPI Code Detail

MEDICARE: DR. RANDEL O CARDOTT M.D.

MEDICARE: DR. RANDEL O CARDOTT M.D.
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
1207Q00000XFamily Medicine Physician036070172IL
2207Q00000XFamily Medicine Physician23849IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295704674
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDEL O CARDOTT M.D.
Provider Business Mailing Address
First Line : 4321 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-1269
Country : US
Telephone Number : 563-421-5310
Fax Number :
Provider Business Practice Location Address
First Line : 4321 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-1269
Country : US
Telephone Number : 563-421-5310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 04/29/2021

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Directions to “ DR. RANDEL O CARDOTT M.D.” Practice Location

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