Provider Demographics
NPI:1679541858
Name:CANOS, COURTNEY R (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:CANOS
Suffix:
Gender:F
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:PO BOX 4125
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025
Mailing Address - Country:US
Mailing Address - Phone:812-537-5759
Mailing Address - Fax:812-537-9974
Practice Address - Street 1:132 INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-5759
Practice Address - Fax:812-537-9974
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057671A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200459830Medicaid
I40767Medicare UPIN
IN172580XMedicare PIN