Provider Demographics
NPI:1033163571
Name:KANU, BAI (MD)
Entity Type:Individual
Prefix:
First Name:BAI
Middle Name:
Last Name:KANU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 LEA DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4384
Mailing Address - Country:US
Mailing Address - Phone:301-262-7113
Mailing Address - Fax:301-805-0114
Practice Address - Street 1:3233 SUPERIOR LN
Practice Address - Street 2:B 21
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1920
Practice Address - Country:US
Practice Address - Phone:301-805-2500
Practice Address - Fax:301-805-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD432360200Medicaid
MDG01360PO1Medicare ID - Type Unspecified
MD106N010GMedicare ID - Type Unspecified
H60663Medicare UPIN