Provider Demographics
NPI:1427059237
Name:CORDANO, FLAVIO (DPM)
Entity type:Individual
Prefix:DR
First Name:FLAVIO
Middle Name:
Last Name:CORDANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5076
Mailing Address - Country:US
Mailing Address - Phone:815-226-7100
Mailing Address - Fax:815-381-0776
Practice Address - Street 1:534 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5076
Practice Address - Country:US
Practice Address - Phone:815-226-7100
Practice Address - Fax:815-381-0776
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2015-02-13
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
IL004609213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-004609Medicaid
IL974493Medicare ID - Type Unspecified
ILU30525Medicare UPIN