Healthcare Provider Details

I. General information

NPI: 1396650727
Provider Name (Legal Business Name): CLIFTON CANALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E ELM AVE APT 305
MONROE MI
48162-2675
US

IV. Provider business mailing address

215 E ELM AVE APT 305
MONROE MI
48162-2675
US

V. Phone/Fax

Practice location:
  • Phone: 734-364-8778
  • Fax:
Mailing address:
  • Phone: 734-364-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC542119730964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: