Individual
MICHAEL B CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5224 E I 240 SERVICE RD STE 201, OKLAHOMA CITY, OK 73135-2607
(405) 608-3800
(405) 242-5962
Mailing address
7800 NW 85TH TER, OKLAHOMA CITY, OK 73132-3385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
17716
OK
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
17716
OK
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
K8048
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045603002
—
TX
05
—
100137740A
—
OK
05
—
138370001
—
AR
01
—
87491N
BL TX
TX
Enumeration date
09/13/2005
Last updated
06/06/2022
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