Provider Demographics
NPI:1295795318
Name:CANGAS, JOSEPH EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:CANGAS
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 1:1550 N MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1070
Mailing Address - Country:US
Mailing Address - Phone:618-281-4325
Mailing Address - Fax:618-281-8393
Practice Address - Street 1:1550 N MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1070
Practice Address - Country:US
Practice Address - Phone:618-281-4325
Practice Address - Fax:618-281-8393
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007755208000000X
IL036110913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110913Medicaid
ILI115533Medicare UPIN