Provider Demographics
NPI:1871688218
Name:CANFIELD, CHERYL A B (D O)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A B
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 VOLZ CT
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1624
Mailing Address - Country:US
Mailing Address - Phone:989-551-9088
Mailing Address - Fax:989-954-3585
Practice Address - Street 1:660 VOLZ CT
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1624
Practice Address - Country:US
Practice Address - Phone:989-551-9088
Practice Address - Fax:989-954-3585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC010859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3277996Medicaid
MI3277996Medicaid
MIF54829Medicare UPIN