Provider Demographics
NPI:1538663117
Name:NAGAO, KANAE JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAE
Middle Name:JENNIFER
Last Name:NAGAO
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 1:2799 W. GRAND BOULEVARD HENRY FORD HOSPITAL,
Mailing Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-2644
Mailing Address - Fax:313-916-3014
Practice Address - Street 1:HENRY FORD HOSPITAL, 2799 W. GRAND BOULEVARD
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2644
Practice Address - Fax:313-916-3014
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-11-13
Deactivation Date:2018-10-25
Deactivation Code:
Reactivation Date:2018-11-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program