Provider Demographics
NPI:1619903093
Name:CANAS, SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CANAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 WESTGATE DR
Mailing Address - Street 2:SUITE 149
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-8612
Mailing Address - Country:US
Mailing Address - Phone:651-641-2900
Mailing Address - Fax:651-641-2901
Practice Address - Street 1:1000 WESTGATE DR
Practice Address - Street 2:SUITE 149
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-8612
Practice Address - Country:US
Practice Address - Phone:651-641-2900
Practice Address - Fax:651-641-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33789Medicare UPIN