Canonico, Domenic Michael

Canonico, Domenic Michael is an individual health care provider with primary practice located at 507 Nw Atlantic St , Tullahoma TN 37388-3504. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck, which is considered as his primary health care specialty. Canonico, Domenic Michael can be contacted via phone (931) 393-4332.

Contact Information

Primary practice address
507 Nw Atlantic St Tullahoma TN 37388-3504
Phone: (931) 393-4332
Fax: (931) 393-2304
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck 207YX0007X 18819 Tennessee

Profile Details

NPI number 1770551640
LBN Legal business name Canonico, Domenic Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2006
Last updated Jul 14th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1770551640 NPPES
Tennessee Other 0192943 BCBS
Tennessee Other 040013804 BCBS
Tennessee MEDICAID 3085592 BCBS

Popular Providers