Provider Demographics
NPI:1972509065
Name:VAN NESS, MICHAEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:VAN NESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3506
Mailing Address - Country:US
Mailing Address - Phone:330-455-5011
Mailing Address - Fax:330-588-7127
Practice Address - Street 1:2726 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3506
Practice Address - Country:US
Practice Address - Phone:330-455-5011
Practice Address - Fax:330-588-7127
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.056937207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1313725002OtherCIGNA #
OH4292973OtherAETNA #
OH2900128OtherUNITED HEALTHCARE
OH100005924OtherRR MEDICARE PIN #
OH341773267OtherCOMMERCIAL CARRIERS
OH0705124Medicaid
OH87852OtherQUALCHOICE #
OH000000138314OtherANTHEM BCBS #
OH341773267AOtherAULTCARE #
OH0705124Medicaid
OH2900128OtherUNITED HEALTHCARE