Individual
LUIS IVAN CANALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
181 MAPLE STREET, SUITE C, MASSENA, NY 13662
(315) 769-1667
(315) 769-6430
Mailing address
PO BOX 217, MASSENA, NY 13662-0217
(315) 769-1667
(315) 769-6430
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
208001
NY
207RG0100X
Gastroenterology Physician
Primary
208001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01794976
—
NY
Enumeration date
08/12/2005
Last updated
07/10/2024
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