Provider Demographics
NPI:1689102022
Name:KANAYOCHUKWU J. ANYA MD FACS, PLLC
Entity Type:Organization
Organization Name:KANAYOCHUKWU J. ANYA MD FACS, PLLC
Other - Org Name:ANYA BARIATRICS & AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANAYOCHUKWU KANNY
Authorized Official - Middle Name:JACQUELYNE
Authorized Official - Last Name:ANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:817-759-9008
Mailing Address - Street 1:6100 HARRIS PARKWAY
Mailing Address - Street 2:380
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-759-9008
Mailing Address - Fax:844-583-5414
Practice Address - Street 1:6100 HARRIS PKWY STE 380
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4128
Practice Address - Country:US
Practice Address - Phone:817-759-9008
Practice Address - Fax:844-583-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty