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General NPI Number Information
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NPI Number | 1376842591
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Entity Type | Individual
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Provider Name | TERATA ANN KANU M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2122 RUFE SNOW DR STE 132
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City | KELLER
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State | TX
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Zip | 76248-5691
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Country | US
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Telephone | 817-576-4050
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Fax | 817-796-1422
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Provider Business Mailing Address
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Address Line | 2122 RUFE SNOW DR STE 132
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City | KELLER
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State | TX
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Zip | 76248-5691
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Country | US
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Telephone | 817-576-4050
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Fax | 817-796-1422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | Q6039
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | Q6039
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | Q6039
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q6039
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License Number State | TX
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