Provider Demographics
NPI:1538515200
Name:KANNA, ANILA (MD)
Entity Type:Individual
Prefix:MISS
First Name:ANILA
Middle Name:
Last Name:KANNA
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 1:28631 THORNEAPPLE DRIVE
Mailing Address - Street 2:APARTMENT #102
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:508-471-6560
Mailing Address - Fax:
Practice Address - Street 1:648 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8261
Practice Address - Country:US
Practice Address - Phone:985-805-2555
Practice Address - Fax:985-400-5303
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2021-06-10
Deactivation Date:2017-01-10
Deactivation Code:
Reactivation Date:2017-08-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA3270082084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program