Active NPI
Louis A Cannon, MD
- Interventional Cardiology Physician
- Petoskey, MI
National Provider Identifier
1316960487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- 4301058141
- Practice address
- 560 W Mitchell St
Suite 400
Petoskey, MI 49770-2275 - Phone
- (231) 487-2490
- Fax
- (231) 487-6055
- NPI assigned
- Jul 26, 2006
- Last updated
- Aug 6, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 4301058141 | MI | |
| Interventional Cardiology Physician | 207RI0011X | 4301058141 | MI | Primary |
Addresses
Primary practice location
560 W Mitchell St
Suite 400
Petoskey, MI 49770-2275
Mailing address
560 W Mitchell St
Suite 400
Petoskey, MI 49770-2275
Phone (231) 487-2490
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0607313061 | Other | MI | BLUE SHIELD INDIVIDUAL PI |
| 4636434 | Medicaid | MI | |
| P64823 | Other | MI | BLUE CARE NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407283200000",
"number": "1316960487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "560 W MITCHELL ST",
"address_2": "SUITE 400",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702275",
"telephone_number": "231-487-2490",
"fax_number": "231-487-6055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 W MITCHELL ST",
"address_2": "SUITE 400",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702275",
"telephone_number": "231-487-2490",
"fax_number": "231-487-6055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "LOUIS",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2014-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MI",
"license": "4301058141",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "MI",
"license": "4301058141",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD INDIVIDUAL PI",
"identifier": "0607313061",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4636434",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "P64823",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petoskey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.