Provider Demographics
NPI:1982666236
Name:CANNON, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:CANNON
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 1:1 MT. CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-231-6100
Mailing Address - Fax:316-262-0706
Practice Address - Street 1:1 MT. CARMEL WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-231-6100
Practice Address - Fax:316-262-0706
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418085207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1286700004OtherDMERC REGION 1
KS1286700009OtherDMERC REGION 1
KS1286700013OtherDMERC REGION 1
KS100189850AMedicaid
KS1286700003OtherDMERC REGION 1
KS1286700011OtherDMERC REGION 1
KS1286700015OtherDMERC REGION 1
KS1286700002OtherDMERC REGION 1
KS1286700006OtherDMERC REGION 1
1286700008OtherDMERC REGION 1
KS1286700005OtherDMERC REGION 1
KS1286700007OtherDMERC REGION 1
KS1286700012OtherDMERC REGION 1
KS12867010010OtherDMERC REGION 1
KS1286700002OtherDMERC REGION 1
KS100189850AMedicaid