Individual
MARK ANTHONY GARDON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 E CHESTNUT ST STE 303, LOUISVILLE, KY 40202-1831
(502) 629-5552
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 559-9425
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05853
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100845360
—
KY
Enumeration date
03/30/2021
Last updated
07/31/2024
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