Healthcare Provider Details

I. General information

NPI: 1689889123
Provider Name (Legal Business Name): STEVEN PAUL KANIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 CALLE DE DANIEL NW
ALBUQUERQUE NM
87104-3023
US

IV. Provider business mailing address

3325 CALLE DE DANIEL NW
ALBUQUERQUE NM
87104-3023
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-1134
  • Fax: 505-242-1134
Mailing address:
  • Phone: 505-242-1134
  • Fax: 505-242-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number78-44
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: