Basic Information
| Provider Information | |||||||||
| NPI: | 1528152139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANFIELD | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 S EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487063319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898934506 | ||||||||
| FaxNumber: | 9898933770 | ||||||||
| Practice Location | |||||||||
| Address1: | 5570 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895830100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101010429 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | EC010429 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3277987 | 05 | MI | MEDICAID |