Provider Demographics
NPI:1003912783
Name:CANTY, MICHAEL DON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DON
Last Name:CANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 23RD ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2845
Mailing Address - Country:US
Mailing Address - Phone:606-324-3188
Mailing Address - Fax:606-329-2237
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 11
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2845
Practice Address - Country:US
Practice Address - Phone:606-324-3188
Practice Address - Fax:606-329-2237
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY28207207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000049731OtherANTHEM INSURANCE
KY64282072Medicaid
000000049731OtherANTHEM INSURANCE
KY64282072Medicaid