Provider Demographics
NPI:1417406554
Name:KADOO, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:KADOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W WARREN AVE
Mailing Address - Street 2:APT 315
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-3714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:665 W WARREN AVE
Practice Address - Street 2:APT 315
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3714
Practice Address - Country:US
Practice Address - Phone:313-924-7860
Practice Address - Fax:313-924-0350
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program