Provider Demographics
NPI:1306939822
Name:MOHAMED FAROUK KANAA M.D., INC.
Entity type:Organization
Organization Name:MOHAMED FAROUK KANAA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANOWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:FAROUK
Authorized Official - Last Name:KANAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-752-0871
Mailing Address - Street 1:13301 N MERIDIAN AVE
Mailing Address - Street 2:BUILDING 500, SUITE 501
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9369
Mailing Address - Country:US
Mailing Address - Phone:405-752-0871
Mailing Address - Fax:405-755-9510
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:BUILDING 500, SUITE 501
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-752-0871
Practice Address - Fax:405-755-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100735300AMedicaid
OKCI4545OtherRAILROAD MEDICARE GROUP #
OK800522037Medicare ID - Type UnspecifiedGROUP MEDICARE #