Provider Demographics
NPI:1457353732
Name:CANNATA, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:CANNATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1501 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-8188
Mailing Address - Country:US
Mailing Address - Phone:620-672-7422
Mailing Address - Fax:620-450-1601
Practice Address - Street 1:203 WATSON ST
Practice Address - Street 2:STE 200
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3066
Practice Address - Country:US
Practice Address - Phone:620-672-7422
Practice Address - Fax:620-450-1601
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB91113Medicare UPIN
KS054489Medicare ID - Type Unspecified