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NPI Code Detail

MEDICARE: CARDINAL MEDICAL PROVIDER INC

MEDICARE: CARDINAL MEDICAL PROVIDER INC
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
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1588208664
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDINAL MEDICAL PROVIDER INC
Provider Business Mailing Address
First Line : 4537 EVERHARD RD NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2406
Country : US
Telephone Number : 330-526-6146
Fax Number : 330-526-6004
Provider Business Practice Location Address
First Line : 4537 EVERHARD RD NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2406
Country : US
Telephone Number : 330-526-6146
Fax Number : 330-526-6004
Authorized Official
Title or Position : OWNER
Name : MICHAEL CAPOBIANCO
Credential :
Telephone Number : 330-361-9455
Provider Enumeration Date : 11/01/2019
Last Update Date : 11/01/2019

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Directions to “CARDINAL MEDICAL PROVIDER INC ” Practice Location

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