Healthcare Provider Details

I. General information

NPI: 1639521347
Provider Name (Legal Business Name): TAREK KANAA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N CLASSEN BLVD
OKLAHOMA CITY OK
73118-2432
US

IV. Provider business mailing address

4220 N CLASSEN BLVD
OKLAHOMA CITY OK
73118-2432
US

V. Phone/Fax

Practice location:
  • Phone: 405-768-5749
  • Fax:
Mailing address:
  • Phone: 405-768-5749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32184
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number32184
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number65689
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: