Individual
DR. GABRIEL CARDENAS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 20, MARYVILLE, IL 62062-8587
(618) 288-2835
(618) 288-6162
Mailing address
521 MEADOW GLEN CT, HOUSE SPRINGS, MO 63051-4320
(618) 514-1308
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016.005608
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
2010021578
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F100153987
MEDICARE GROUP PTAN
IL
Enumeration date
06/28/2010
Last updated
11/17/2016
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