Healthcare Provider Details

I. General information

NPI: 1538262803
Provider Name (Legal Business Name): PADMANEEL B KANASE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MARTIN LUTHER KING JR BLVD
CLOVIS NM
88101
US

IV. Provider business mailing address

1914 APACHE DR
DALHART TX
79022-5202
US

V. Phone/Fax

Practice location:
  • Phone: 505-769-7153
  • Fax: 505-769-7337
Mailing address:
  • Phone: 806-249-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001-50
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: