Provider Demographics
NPI:1225207749
Name:CANADY, KERRY J (DO)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:J
Last Name:CANADY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 NW 128TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325
Mailing Address - Country:US
Mailing Address - Phone:515-224-3948
Mailing Address - Fax:515-224-2944
Practice Address - Street 1:1275 NW 128TH ST
Practice Address - Street 2:STE 200
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:734-502-6716
Practice Address - Fax:515-225-6750
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4187207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine