Provider Demographics
NPI:1649227471
Name:KANATANI, KENT THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:THOMAS
Last Name:KANATANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENT
Other - Middle Name:T
Other - Last Name:KANATANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1022 1ST ST N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8706
Mailing Address - Country:US
Mailing Address - Phone:205-663-4009
Mailing Address - Fax:205-663-9966
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 302
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-663-4009
Practice Address - Fax:205-663-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32690Medicare UPIN