Healthcare Provider Details

I. General information

NPI: 1063507283
Provider Name (Legal Business Name): CANFIELD FAMILY PRACTICE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 UNIONVILLE RD
SEBEWAING MI
48759-1631
US

IV. Provider business mailing address

616 UNIONVILLE RD
SEBEWAING MI
48759-1631
US

V. Phone/Fax

Practice location:
  • Phone: 989-883-9088
  • Fax: 989-883-3551
Mailing address:
  • Phone: 989-883-9088
  • Fax: 989-883-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD J CANFIELD
Title or Position: MANAGING PARTNER
Credential: D.O.
Phone: 989-883-9088