Provider Demographics
NPI:1689406324
Name:CARDER, MICHAEL ADAM
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:CARDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1906
Mailing Address - Country:US
Mailing Address - Phone:330-234-6284
Mailing Address - Fax:
Practice Address - Street 1:125 STADIUM DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1906
Practice Address - Country:US
Practice Address - Phone:330-234-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist