Basic Information
| Provider Information | |||||||||
| NPI: | 1174016935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDONA | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | W126N7338 FLINT DR | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530514532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147773754 | ||||||||
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| Practice Location | |||||||||
| Address1: | W168N11237 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530223239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622535060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2018 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A165502 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 21041-875 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.