Provider Demographics
NPI:1275517328
Name:CANNONE, MICHAEL B (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:CANNONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S. CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081
Mailing Address - Country:US
Mailing Address - Phone:614-890-6555
Mailing Address - Fax:614-839-3277
Practice Address - Street 1:5040 FOREST DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054
Practice Address - Country:US
Practice Address - Phone:614-890-6555
Practice Address - Fax:614-839-3277
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006141C207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149731Medicaid
OHCA0875865Medicare PIN
OHCA0875864Medicare PIN
OHCA0875862Medicare PIN
OHCA0875861Medicare ID - Type Unspecified
OH2149731Medicaid