MEDICARE: DANIEL L CARDWELL PA-C

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	363A00000X	Physician Assistant	085004797	IL
2	363AS0400X	Surgical Physician Assistant	0110004653	VA
3	363AS0400X	Surgical Physician Assistant	146680	MT

Other Identifiers

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

General Provider Information

NPI Number	:	1336425560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL L CARDWELL PA-C

Provider Business Mailing Address
First Line	:	12251 S 80TH AVE STE 1520
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4200
Fax Number	:	708-923-4201

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE STE 1520
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4200
Fax Number	:	708-923-4201

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	06/01/2026

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Directions to “ DANIEL L CARDWELL PA-C” Practice Location

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