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Individual

MICHAEL LOUIS CANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255

Taxonomy

Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
0095-00033
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1131R
BLUE CROSS
NC
05
2004805000
WV
01
24396
PARTNERS
NC
01
5445723
AETNA
NC
05
6729746
VA
01
79555
MEDCOST
NC
05
891131R
NC
05
Q00031
SC
Enumeration date
12/27/2005
Last updated
11/11/2016
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