Individual
MIKE DECARDENAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 SW 75TH AVE, MIAMI, FL 33155-2800
(305) 260-1852
Mailing address
6230 SW 144TH ST, VILLAGE OF PALMETTO BAY, FL 33158-1827
(305) 310-5451
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME44880
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069854700
—
FL
01
—
104014
AVMED
FL
01
—
50380
BCBS
FL
01
—
592461
NHP
FL
01
—
96568
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/14/2007
Last updated
09/04/2008
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