Provider Demographics
NPI:1831137165
Name:CANOVA, ANDRES EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:EDUARDO
Last Name:CANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2387
Mailing Address - Country:US
Mailing Address - Phone:561-227-5127
Mailing Address - Fax:561-455-9975
Practice Address - Street 1:8645 NORTH MILITARY TRAIL
Practice Address - Street 2:SUITE 408
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6294
Practice Address - Country:US
Practice Address - Phone:855-867-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83256207R00000X, 207RH0003X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264946200Medicaid
FL06029Medicare ID - Type Unspecified
FL264946200Medicaid