Provider Demographics
NPI:1063507283
Name:CANFIELD FAMILY PRACTICE, LLP
Entity Type:Organization
Organization Name:CANFIELD FAMILY PRACTICE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-883-9088
Mailing Address - Street 1:616 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1631
Mailing Address - Country:US
Mailing Address - Phone:989-883-9088
Mailing Address - Fax:989-883-3551
Practice Address - Street 1:616 UNIONVILLE RD
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1631
Practice Address - Country:US
Practice Address - Phone:989-883-9088
Practice Address - Fax:989-883-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29370Medicare ID - Type Unspecified