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NPI Code Detail

MEDICARE: MIKE DECARDENAS MD

MEDICARE: MIKE DECARDENAS MD
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
1174400000XSpecialistME44880FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
250380OTHERFLBCBS
396568OTHERFLBLUE CROSS BLUE SHIELD
4104014OTHERFLAVMED
5592461OTHERFLNHP

General Provider Information

NPI Number : 1467585828
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE DECARDENAS MD
Provider Business Mailing Address
First Line : 6230 SW 144TH ST
Second Line :
City : VILLAGE OF PALMETTO BAY
State : FL
Zip : 33158-1827
Country : US
Telephone Number : 305-310-5451
Fax Number :
Provider Business Practice Location Address
First Line : 2525 SW 75TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33155-2800
Country : US
Telephone Number : 305-260-1852
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 09/04/2008

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Directions to “ MIKE DECARDENAS MD” Practice Location

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