Basic Information
| Provider Information | |||||||||
| NPI: | 1659370286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDINALI | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E CHESTNUT ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295552 | ||||||||
| FaxNumber: | 5026293132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 31278 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 31278 | KY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 200270810 | 05 | IN | MEDICAID | 055106 | 01 | KY | SIHO - NICS | OTHER | 3775844 | 01 | KY | CIGNA - NICS | OTHER | 64312788 | 05 | KY | MEDICAID | 000000626499 | 01 | KY | ANTHEM - NICS | OTHER | 50025058 | 01 | KY | PASSPORT - NICS | OTHER | 000028412P | 01 | KY | HUMANA - NICS | OTHER | 3730045000 | 01 | KY | PASSPORT ADVANTAGE - NICS | OTHER | 5318655 | 01 | KY | AETNA - NICS | OTHER |