Basic Information
| Provider Information | |||||||||
| NPI: | 1093057630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDONELL | ||||||||
| FirstName: | MAGGIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FEY | ||||||||
| OtherFirstName: | MAGGIE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 843966 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738843300 | ||||||||
| FaxNumber: | 5738840943 | ||||||||
| Practice Location | |||||||||
| Address1: | 3215 WINGATE COURT, STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652017214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738828920 | ||||||||
| FaxNumber: | 5738844868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2013 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0110X | 2018008043 | MO | N | 207W00000X | 2018008043 | MO | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 130882 | OH | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0110X | 130882 | OH | N |
No ID Information.