Dr. Octavia Manetta Cannon, D.O.
Obstetrics & Gynecology in East Lansing, MI. Individual provider (NPI-1).
NPI number1497734701
StatusActive
Last updated in NPPESSep 2, 2021
Details
- NPI
- 1497734701
- Entity type
- Individual (NPI-1)
- Name
- Dr. Octavia Manetta Cannon
- Credential
- D.O.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 13, 2006
- Certification date
- Sep 2, 2021
- Last updated
- Sep 2, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OBSTETRICS/GYNECOLOGY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207V00000X | Obstetrics & Gynecology | 5101012864 | MI | Yes |
| 174400000X | Specialist | 9900020 | NC | |
| 207V00000X | Obstetrics & Gynecology | 99-00020 | NC |
Practice location
1560 Turf LnEast Lansing, MI 48823-6392
Phone 517-484-3000
Mailing address
1560 Turf LnEast Lansing, MI 48823-6392
Phone 517-484-3000 · Fax 517-484-6358
Other practice locations
1100 S Cedar St
Mason, MI 48854-2009
Mason, MI 48854-2009
Phone 517-484-3000
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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