Provider Demographics
NPI:1376529404
Name:KANU, HAZEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:HAZEL
Middle Name:E
Last Name:KANU
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 1:3101 BURNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3098
Mailing Address - Country:US
Mailing Address - Phone:513-357-7289
Mailing Address - Fax:513-352-3137
Practice Address - Street 1:3301 BEEKMAN ST
Practice Address - Street 2:MILLVALE HEALTH CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1205
Practice Address - Country:US
Practice Address - Phone:513-352-3192
Practice Address - Fax:513-352-3137
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH257994Medicaid
F76334Medicare UPIN
KA2013601Medicare ID - Type Unspecified