Provider Demographics
NPI:1548300056
Name:CANLAS, NOEL D (MD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:D
Last Name:CANLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 638706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8706
Mailing Address - Country:US
Mailing Address - Phone:270-827-7558
Mailing Address - Fax:270-827-7530
Practice Address - Street 1:1305 N ELM ST
Practice Address - Street 2:SUITE G
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2783
Practice Address - Country:US
Practice Address - Phone:270-826-0002
Practice Address - Fax:270-826-0003
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18731207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64187313Medicaid
KYC69535Medicare UPIN
KY408113366Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN408113355Medicare ID - Type Unspecified
KY64187313Medicaid