Healthcare Provider Details

I. General information

NPI: 1306939822
Provider Name (Legal Business Name): MOHAMED FAROUK KANAA M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN AVE BUILDING 500, SUITE 501
OKLAHOMA CITY OK
73120-9369
US

IV. Provider business mailing address

13301 N MERIDIAN AVE BUILDING 500, SUITE 501
OKLAHOMA CITY OK
73120-9369
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-0871
  • Fax: 405-755-9510
Mailing address:
  • Phone: 405-752-0871
  • Fax: 405-755-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED FAROUK KANAA
Title or Position: PHYSICIANOWNER
Credential: M.D.
Phone: 405-752-0871