Healthcare Provider Details

I. General information

NPI: 1659366714
Provider Name (Legal Business Name): ENAS KANAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W WOOSTER ST
BOWLING GREEN OH
43402-2603
US

IV. Provider business mailing address

745 HASKINS RD SUITE B
BOWLING GREEN OH
43402-1637
US

V. Phone/Fax

Practice location:
  • Phone: 419-354-8900
  • Fax:
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35079970
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036165599
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: