Provider Demographics
NPI:1043923428
Name:MCKAIN, CANUTE LIVINGSTONE JR
Entity Type:Individual
Prefix:PROF
First Name:CANUTE
Middle Name:LIVINGSTONE
Last Name:MCKAIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5563
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32728-5563
Mailing Address - Country:US
Mailing Address - Phone:386-898-6238
Mailing Address - Fax:
Practice Address - Street 1:1065 ABAGAIL DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-6468
Practice Address - Country:US
Practice Address - Phone:386-898-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM250-112-64-341-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL172A00000XMedicaid