Provider Demographics
NPI:1306898044
Name:DEVA CAANTHAN, KANAGASAB (MD)
Entity type:Individual
Prefix:
First Name:KANAGASAB
Middle Name:
Last Name:DEVA CAANTHAN
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 1:7981 GLADIOLUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-939-0999
Mailing Address - Fax:239-425-0795
Practice Address - Street 1:7981 GLADIOLUS DRIVE
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-939-0999
Practice Address - Fax:239-425-0795
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 26880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57407400Medicaid
FL78500ZMedicare PIN
FLD58522Medicare UPIN