MEDICARE: CHRISTOPHER S 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	363AS0400X	Surgical Physician Assistant
2	363AM0700X	Medical Physician Assistant	6651	AZ

General Provider Information

NPI Number	:	1538537782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER S CARDWELL PA-C

Provider Business Mailing Address
First Line	:	2550 N THUNDERBIRD CIR SUITE 303
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215
Country	:	US
Telephone Number	:	888-381-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 N THUNDERBIRD CIR STE 303
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1219
Country	:	US
Telephone Number	:	888-381-4858
Fax Number	:

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

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	07/21/2022

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