MEDICARE: JUAN JAVIER CARDENAS 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
1	207W00000X	Ophthalmology Physician	ME39538	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699855916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN JAVIER CARDENAS M.D.

Provider Business Mailing Address
First Line	:	6200 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4245
Country	:	US
Telephone Number	:	407-291-9023
Fax Number	:	407-290-9501

Provider Business Practice Location Address
First Line	:	6200 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4245
Country	:	US
Telephone Number	:	407-291-9023
Fax Number	:	407-290-9501

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/08/2008

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