Provider Demographics
NPI:1093975658
Name:CANTOR VARELA, MANUEL ENRRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ENRRIQUE
Last Name:CANTOR VARELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2112
Mailing Address - Country:US
Mailing Address - Phone:269-982-4862
Mailing Address - Fax:269-985-4523
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-982-4862
Practice Address - Fax:269-985-4523
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140866208M00000X
MI4301101854208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201027660Medicaid
IN201027660Medicaid
INP00973512Medicare PIN