Provider Demographics
NPI:1790788990
Name:CANIZA, MIGUELA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUELA
Middle Name:A
Last Name:CANIZA
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 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN292972080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124592Medicaid
LA1106674Medicaid
MO205358401Medicaid
IA0547141Medicaid
AR145066001Medicaid
IN200341290AMedicaid
ME422400000Medicaid
OK100011140AMedicaid
TX177330101Medicaid
TN3899243Medicaid
KY64037997Medicaid
WY1165135 00Medicaid
NJ0076023Medicaid
AL009964160Medicaid
NC7614121Medicaid
KY64037997Medicaid