Provider Demographics
NPI:1174524599
Name:CARDONA, ANTONIO IGNACIO JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:IGNACIO
Last Name:CARDONA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3704
Mailing Address - Country:US
Mailing Address - Phone:305-548-3301
Mailing Address - Fax:305-548-3032
Practice Address - Street 1:1390 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3704
Practice Address - Country:US
Practice Address - Phone:305-548-3301
Practice Address - Fax:305-548-3032
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96664OtherBLUE CROSS
FL036113500Medicaid
FL96664OtherBLUE CROSS
FL96664Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
FL036113500Medicaid