Provider Demographics
NPI:1528152139
Name:CANFIELD, EDWARD J (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:CANFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3319
Mailing Address - Country:US
Mailing Address - Phone:989-893-4506
Mailing Address - Fax:989-893-3770
Practice Address - Street 1:5570 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3583
Practice Address - Country:US
Practice Address - Phone:989-583-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010429207Q00000X
MIEC010429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3277987Medicaid
MIE40002Medicare UPIN
MI0M29370Medicare ID - Type Unspecified