Provider Demographics
NPI:1760635486
Name:CANTOR, MICHAEL DAN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAN
Last Name:CANTOR
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-7800
Mailing Address - Fax:980-302-7805
Practice Address - Street 1:134 MEDICAL PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8527
Practice Address - Country:US
Practice Address - Phone:980-302-7800
Practice Address - Fax:980-302-7805
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01999207RC0000X, 207RI0011X
NH18227207RI0011X
PAOS012779207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3109451Medicaid
OK200252650AMedicaid
VA1760635486Medicaid
P00773739OtherRAILROAD MEDICARE
AR178146001Medicaid
TX203771501Medicaid