Provider Demographics
NPI:1164844973
Name:CANIO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CANIO
Suffix:
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 1:420 CEDAR GLEN DR
Mailing Address - Street 2:APT. 4
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6208
Mailing Address - Country:US
Mailing Address - Phone:800-638-7564
Mailing Address - Fax:734-994-8457
Practice Address - Street 1:812 AVIS DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9649
Practice Address - Country:US
Practice Address - Phone:800-638-7564
Practice Address - Fax:734-994-8457
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other