Provider Demographics
NPI:1952309130
Name:KANUN, CARL STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:STANLEY
Last Name:KANUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N WILMOT RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2618
Mailing Address - Country:US
Mailing Address - Phone:520-885-0823
Mailing Address - Fax:520-885-6337
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:SUITE 305
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-885-0823
Practice Address - Fax:520-885-6337
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8892207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86041556007OtherPACIFICARE
AZAZ0812280OtherBCBS
AZ1Z2046OtherHEALTH NET
AZ222836Medicaid
AZAZ0812280OtherBCBS
Z0000BGJJBMedicare ID - Type Unspecified