Healthcare Provider Details

I. General information

NPI: 1033463252
Provider Name (Legal Business Name): MICHAEL S. CANN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD SUITE 112
GLENDALE CA
91208-1477
US

IV. Provider business mailing address

1808 VERDUGO BLVD SUITE 112
GLENDALE CA
91208-1477
US

V. Phone/Fax

Practice location:
  • Phone: 818-949-7380
  • Fax: 818-949-7384
Mailing address:
  • Phone: 818-949-7380
  • Fax: 818-949-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG23476
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL STERLING CANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-949-7380