Basic Information
| Provider Information | |||||||||
| NPI: | 1306865910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARDELLIO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6483 CITATION DR STE B | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483462994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488610010 | ||||||||
| FaxNumber: | 2488610020 | ||||||||
| Practice Location | |||||||||
| Address1: | 50505 SCHOENHERR RD STE 230 | ||||||||
| Address2: | |||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5868033484 | ||||||||
| FaxNumber: | 5868033354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101014635 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4501513 | 05 | MI | MEDICAID |