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General NPI Number Information
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NPI Number | 1518969260
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Entity Type | Individual
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Provider Name | LUIS IVAN CANALES M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 181 MAPLE STREET SUITE C
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City | MASSENA
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State | NY
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Zip | 13662
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Country | US
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Telephone | 315-769-1667
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Fax | 315-769-6430
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Provider Business Mailing Address
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Address Line | PO BOX 217
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City | MASSENA
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State | NY
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Zip | 13662-0217
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Country | US
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Telephone | 315-769-1667
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Fax | 315-769-6430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 208001
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 208001
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License Number State | NY
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