Provider Demographics
NPI:1215326566
Name:KAN ANESTHESIA,LLC
Entity type:Organization
Organization Name:KAN ANESTHESIA,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-734-6932
Mailing Address - Street 1:3439 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3884
Mailing Address - Country:US
Mailing Address - Phone:727-734-6932
Mailing Address - Fax:727-734-4516
Practice Address - Street 1:3439 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3884
Practice Address - Country:US
Practice Address - Phone:727-734-6932
Practice Address - Fax:727-734-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty