Provider Demographics
NPI:1396798948
Name:CANADY, MICHAEL R (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:CANADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-1934
Mailing Address - Fax:740-446-5956
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5225
Practice Address - Fax:740-446-5532
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18473208600000X
OH35-06-0982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007322OtherANTHEM BCBS
OH0154256OtherOHIO MEDICAID MOLINA
OH000000181583OtherUNISON MEDICAID
WV0126280000Medicaid
OH310917085091OtherCARESOURCE MEDICAID
001714083OtherMOUNTAIN STATE BCBS
020027086OtherRR MEDICARE
OH0154256OtherMOLINA MEDICAID
G05995Medicare UPIN
OH000000181583OtherUNISON MEDICAID
OH0154256OtherOHIO MEDICAID MOLINA