Provider Demographics
NPI:1457480790
Name:KANASE, HEENA NITIN (DO)
Entity Type:Individual
Prefix:DR
First Name:HEENA
Middle Name:NITIN
Last Name:KANASE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HEENA
Other - Middle Name:CHANDRAKANT
Other - Last Name:DHARAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2736 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-1004
Mailing Address - Country:US
Mailing Address - Phone:214-467-7377
Mailing Address - Fax:214-247-7384
Practice Address - Street 1:2736 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-1004
Practice Address - Country:US
Practice Address - Phone:214-467-7377
Practice Address - Fax:214-247-7384
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096264904Medicaid
TX096264903Medicaid
TX096264902Medicaid