Healthcare Provider Details

I. General information

NPI: 1891437679
Provider Name (Legal Business Name): ALIEU SULAIMAN KANU DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MEDICAL DR STE 120
SAN ANTONIO TX
78229-3353
US

IV. Provider business mailing address

4330 MEDICAL DR STE 120
SAN ANTONIO TX
78229-3353
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-3327
  • Fax:
Mailing address:
  • Phone: 210-575-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number692242
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number692242
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number692242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: