Provider Demographics
NPI:1417933151
Name:SHAWKI KANAZI MD PC
Entity type:Organization
Organization Name:SHAWKI KANAZI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWKI
Authorized Official - Middle Name:G
Authorized Official - Last Name:KANAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-527-7577
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0789
Mailing Address - Country:US
Mailing Address - Phone:413-509-1000
Mailing Address - Fax:413-509-1003
Practice Address - Street 1:132 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1621
Practice Address - Country:US
Practice Address - Phone:413-527-7577
Practice Address - Fax:413-529-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9748822Medicaid
MAM15845OtherBLUE CROSS
MA9748822Medicaid
MAM15845OtherBLUE CROSS