Healthcare Provider Details

I. General information

NPI: 1376033605
Provider Name (Legal Business Name): MICHAEL ROCCO CANIGLIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MCINTOSH CIR
JOPLIN MO
64804-3643
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-5665
  • Fax:
Mailing address:
  • Phone: 417-347-4570
  • Fax: 417-347-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2021006316
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: