Provider Demographics
NPI:1538177928
Name:ELIAS KANAAN MD PA
Entity type:Organization
Organization Name:ELIAS KANAAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-298-8426
Mailing Address - Street 1:1173 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4135
Mailing Address - Country:US
Mailing Address - Phone:727-298-8496
Mailing Address - Fax:727-445-7566
Practice Address - Street 1:1173 TURNER ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4135
Practice Address - Country:US
Practice Address - Phone:727-298-8496
Practice Address - Fax:727-445-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252805300Medicaid
FL38165OtherBLUE CROSS
FLK2756Medicare ID - Type Unspecified