Healthcare Provider Details

I. General information

NPI: 1366480980
Provider Name (Legal Business Name): PRANAY R KANAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE # A
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

32 OLDE COLONY DR
SHREWSBURY MA
01545-6309
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License NumberME164964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: