Provider Demographics
NPI:1235455213
Name:DE CANNIERE, DIDIER PIERRE (MD)
Entity type:Individual
Prefix:
First Name:DIDIER
Middle Name:PIERRE
Last Name:DE CANNIERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:SUITE CENTRAL 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-5271
Mailing Address - Fax:305-547-2185
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:SUITE CENTRAL 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-5271
Practice Address - Fax:305-547-2185
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMFC16522086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0020899-00Medicaid
FLDC789ZMedicare PIN