MICHAEL LOUIS CANNON (NPI# 1578540076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578540076 |
| Entity Type | Individual |
| Full Name | MICHAEL LOUIS CANNON |
| Credential | MD |
| Practice Address |
Medical Center Blvd Winston Salem NC 27157-0001 |
| Mailing Address |
Po Box 344 Winston Salem NC 27102-0344 |
| Practice Telephone | 3367162255 |
| Mailing Telephone | 3367162255 |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2016-11-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
0095-00033 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 6729746 | 05 | |
| NC | MEDCOST | 79555 | 01 |
| NC | 891131R | 05 | |
| WV | 2004805000 | 05 | |
| NC | AETNA | 5445723 | 01 |
| NC | BLUE CROSS | 1131R | 01 |
| SC | Q00031 | 05 | |
| NC | PARTNERS | 24396 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861952251 | Michael L Cannon | Counselor | 5206 Walnut Ct, Lithonia, GA 30038-4873 | 2019-03-21 |
| 1902223118 | Michael David Cannon | Psychiatry & Neurology | 6535 N Charles St Ste 300, Baltimore, MD 21204-5824 | 2014-03-25 |
| 1477863504 | Michael Dee Cannon | Psychologist | 9629 Highway 270, Pine Bluff, AR 71602-9493 | 2010-10-07 |
| 1205047594 | Michael T Cannon | Psychiatry & Neurology | 4721 Reading Road, Cincinnati, OH 45237 | 2007-05-25 |
| 1033131495 | Michael J Cannon | Obstetrics & Gynecology | 801 Pole Line Rd W Ste 3880, Twin Falls, ID 83301-5811 | 2006-07-24 |
| 1124080106 | Michael Todd Cannon | Emergency Medicine | 11820 N 177th East Ave, Collinsville, OK 74021-5149 | 2006-04-05 |
| 1811596232 | Michael Kollin Cannon | Physical Therapist | 5107 Beatline Rd Ste 300, Long Beach, MS 39560-3874 | 2020-10-19 |
| 1154823441 | Michael Cannon | Case Manager/Care Coordinator | 301 Nw F St, Grants Pass, OR 97526-2051 | 2018-03-02 |
| 1487036786 | Michael Cannon | Physical Therapist | 11219 Potranco Rd, Building A Suite 110, San Antonio, TX 78253-5848 | 2015-06-23 |
| 1922494673 | Michael Cannon | Podiatrist | 4018 El Indio Hwy, Eagle Pass, TX 78852-6690 | 2015-04-09 |
| Street Address |
MEDICAL CENTER BLVD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27157-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811990815 | Gary Lee Ray | Registered Nurse | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2005-05-23 |
| 1881295418 | Alan Townes Grizzard | Nurse Practitioner | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-11-02 |
| 1003421751 | Nicholas Ryan Tuttle | Nurse Anesthetist, Certified Registered | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-09-10 |
| 1356956122 | Caitlin Marie Clement | Nurse Anesthetist, Certified Registered | Medical Center Blvd, Winston Salem, NC 27103 | 2020-09-09 |
| 1376154591 | Lori Sansone Flores | Nurse Practitioner | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-08-11 |
| 1821609330 | Hannah Carey Walker | Physician Assistant | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-08-10 |
| 1447876883 | Raveena Mahesh Chhabria | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-06-22 |
| 1780205930 | Jason Chin | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-1087 | 2020-04-29 |
| 1972122885 | Bryanna Dean Vesely | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-04-10 |
| 1679102909 | Ameen Barghi | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-2803 | 2020-04-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255960241 | Alexandra Marie Balmaceda | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center Pathology Dept, #1 Medical Center Blvd., Winston-salem, NC 27157 | 2020-04-02 |
| 1164916680 | Jorie Elizabeth Gatts | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Department of Pediatrics, Winston Salem, NC 27157 | 2018-06-18 |
| 1932606555 | Alexi Rae Ellington Webb | Student in an Organized Health Care Education/Training Program | Wake Forest School of Medicine, Dept of Psychiatry, Medical Center Blvd, Winston Salem, NC 27157 | 2018-04-10 |
| 1851896674 | Wasim Muhammad | Student in an Organized Health Care Education/Training Program | Wake Forest School of Medicine Dept. of Psychiatry, Medical Center Blvd, Winston Salem, NC 27157 | 2018-03-25 |
| 1336643535 | Phillip Martin Kostelic | Student in an Organized Health Care Education/Training Program | Anesthesiology - Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-salem, NC 27157 | 2018-03-21 |
| 1831693324 | Aleah Bond | Student in an Organized Health Care Education/Training Program | Anesthesiology Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-salem, NC 27157 | 2018-03-20 |
| 1134644859 | Ilan Binyamin Klein | Urology | Wake Forest Baptist Health, Department of Urology, Medical Center Boulevard, Winston-salem, NC 27157 | 2017-08-03 |
| 1023467529 | Edward John Doyle IIi | Student in an Organized Health Care Education/Training Program | Wake Forest School of Medicine Dept. of Otolaryngology, Watlington Hall 4th Fl. Medical Center Boulevard, Winston-salem, NC 27157 | 2016-06-07 |
| 1477917888 | Jordan Mae Burner | Student in an Organized Health Care Education/Training Program | Graduate Medical Education Office, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-salem, NC 27157 | 2016-04-12 |
| 1174900476 | Kate Elise Winterbottom | Speech-Language Pathologist | 4 Janeway Medical Center Blvd, Hearing and Speech, Winston Salem, NC 27157 | 2015-05-06 |
| Find all providers in zip 27157 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306998034 | Michael Conor Mccrory | Pediatrics | Medical Center Blvd, Department of Anesthesiology, Winston Salem, NC 27157-0001 | 2007-01-16 |
| 1346277993 | Marty B Scott | Pediatrics | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2006-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538691514 | Christen Nicole Seaman | Pediatrics | 333 South Columbia Street, 230 Macnider Hall Cb #7593, Chapel Hill, NC 27599-0001 | 2017-03-30 |
| 1780021451 | Mousumee Shah | Pediatrics | Pediactric Education Ofc, 101 Manning Drive, Cb# 7593, Chapel Hill, NC 27599-0001 | 2013-06-04 |
| 1598010217 | Alan Kent Lassiter | Pediatrics | 10106 Raven Tree Dr, Raleigh, NC 27617-8206 | 2012-07-18 |
| 1891057915 | Melissa Smith | Pediatrics | 417 Macnider, Chapel Hill, NC 27599 | 2012-06-14 |
| 1114110392 | Afsaneh Pirzadeh | Pediatrics | 214 Macnider Building, Cb # 7221, Chapel Hill, NC 27599-0001 | 2007-08-22 |
| 1477600286 | Jenny M Boyd | Pediatrics | 214 Macnider, Cb #7221, Chapel Hill, NC 27599-7221 | 2007-01-04 |
| 1770663726 | Stephen Leinenweber | Pediatrics | Duke Hospital South Trent Dr, Durham, NC 27710-0001 | 2006-10-16 |
| 1417904889 | David A Turner | Pediatrics | 2300 Erwin Road, Durham, NC 27710 | 2006-05-30 |
| 1124086814 | Childrens Acute Care of Fayetteville, P.a. | Pediatrics | 1638 Owen Dr - Picu, Fayetteville, NC 28304-3424 | 2006-05-02 |
| 1174187637 | Wakemed Specialists Group, LLC | Pediatrics | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2019-04-30 |
| Find all providers with the same taxonomy | ||||
| City | WINSTON SALEM |
| Zip Code | 27157 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.