Provider Demographics
NPI:1538262803
Name:KANASE, PADMANEEL B (MD)
Entity type:Individual
Prefix:DR
First Name:PADMANEEL
Middle Name:B
Last Name:KANASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1914 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-5202
Mailing Address - Country:US
Mailing Address - Phone:806-249-0405
Mailing Address - Fax:
Practice Address - Street 1:2100 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:505-769-7153
Practice Address - Fax:505-769-7337
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-50207Q00000X
TXL2362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH47929Medicare UPIN