Provider Demographics
NPI:1427142249
Name:DANNY C SARDON MD PC
Entity type:Organization
Organization Name:DANNY C SARDON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:SARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-872-7555
Mailing Address - Street 1:1501 WABASH ST
Mailing Address - Street 2:#201
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4357
Mailing Address - Country:US
Mailing Address - Phone:219-872-7555
Mailing Address - Fax:219-872-8671
Practice Address - Street 1:1501 WABASH ST
Practice Address - Street 2:#201
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4357
Practice Address - Country:US
Practice Address - Phone:219-872-7555
Practice Address - Fax:219-872-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL91108125OtherBLUE CROSS/BLUE SHIELD IL
IN200886590AMedicaid
INB29051Medicare UPIN
IL91108125OtherBLUE CROSS/BLUE SHIELD IL