Individual
DR. LOUIS A CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
560 W MITCHELL ST, SUITE 400, PETOSKEY, MI 49770-2275
(231) 487-2490
(231) 487-6055
Mailing address
560 W MITCHELL ST, SUITE 400, PETOSKEY, MI 49770-2275
(231) 487-2490
(231) 487-6055
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
4301058141
MI
207RI0011X
Interventional Cardiology Physician
Primary
4301058141
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0607313061
BLUE SHIELD INDIVIDUAL PI
MI
05
—
4636434
—
MI
01
—
P64823
BLUE CARE NETWORK
MI
Enumeration date
07/26/2006
Last updated
08/06/2014
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