Provider Demographics
NPI:1144486515
Name:KANOOZ, SAMIA YAQUB (MD)
Entity type:Individual
Prefix:
First Name:SAMIA
Middle Name:YAQUB
Last Name:KANOOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARROW SPRINGS BLVD STE 2700
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ARROW SPRINGS BLVD STE 2700
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-282-7911
Practice Address - Fax:513-282-7900
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085308OtherOHIO MEDICAID CARESOURCE
OH0069453Medicaid
WV3810023904Medicaid
OH000000495914OtherOH MEDICAID UNISON
OH0069453Medicaid