Provider Demographics
NPI:1053344994
Name:CARDELLIO, ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CARDELLIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:CARDELLIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:30950 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-6505
Mailing Address - Country:US
Mailing Address - Phone:586-573-3500
Mailing Address - Fax:586-573-8897
Practice Address - Street 1:30950 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6505
Practice Address - Country:US
Practice Address - Phone:586-573-3500
Practice Address - Fax:586-573-8897
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005761207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053344994OtherNPI
MI1073542742OtherNPI
MIE25476Medicare UPIN
MIG71843Medicare ID - Type Unspecified