Provider Demographics
NPI:1124084785
Name:CANFIELD, MICHAEL ELLISON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELLISON
Last Name:CANFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 N DEAN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-9454
Mailing Address - Country:US
Mailing Address - Phone:334-821-2708
Mailing Address - Fax:334-821-3309
Practice Address - Street 1:890 N DEAN RD STE 500
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-9454
Practice Address - Country:US
Practice Address - Phone:334-821-2708
Practice Address - Fax:334-821-3309
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC720667522Medicare PIN
SCC720665277Medicare PIN
SC080092855Medicare PIN
SCC720667555Medicare PIN
SC179050Medicaid
SCC720665281Medicare PIN
SCC720667498Medicare PIN
SCC720666882Medicare PIN
SCC720667006Medicare PIN
SCAA52197126Medicare PIN
SCC720666834Medicare PIN
SCC720666868Medicare PIN
SCC72066Medicare UPIN
SCC720665282Medicare PIN
SCC720667499Medicare PIN