Healthcare Provider Details

I. General information

NPI: 1831137165
Provider Name (Legal Business Name): ANDRES EDUARDO CANOVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 NORTH MILITARY TRAIL SUITE 408
PALM BEACH GARDENS FL
33410-6294
US

IV. Provider business mailing address

5300 EAST AVE
WEST PALM BEACH FL
33407-2387
US

V. Phone/Fax

Practice location:
  • Phone: 855-867-6224
  • Fax:
Mailing address:
  • Phone: 561-227-5127
  • Fax: 561-455-9975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME83256
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME83256
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME83256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: