Healthcare Provider Details

I. General information

NPI: 1801983408
Provider Name (Legal Business Name): HENRY J KANAREK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 W 109TH ST
OVERLAND PARK KS
66211-1318
US

IV. Provider business mailing address

32031 W 143RD ST
GARDNER KS
66030-9726
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-8555
  • Fax:
Mailing address:
  • Phone: 913-451-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberR4P09
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: