Provider Demographics
NPI:1144564725
Name:KANAK, MICHAEL J (BS,HIS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:KANAK
Suffix:
Gender:M
Credentials:BS,HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHALFORD PL
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-7603
Mailing Address - Country:US
Mailing Address - Phone:615-945-4327
Mailing Address - Fax:
Practice Address - Street 1:115 CHALFORD PL
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-7603
Practice Address - Country:US
Practice Address - Phone:615-945-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN631237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist