Provider Demographics
NPI:1023291705
Name:KANAMA, MALEK A
Entity type:Individual
Prefix:DR
First Name:MALEK
Middle Name:A
Last Name:KANAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MALEK
Other - Middle Name:A
Other - Last Name:KANAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:47 PLAYER POINT DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2896
Mailing Address - Country:US
Mailing Address - Phone:813-956-3730
Mailing Address - Fax:
Practice Address - Street 1:18955 N MEMORIAL DR STE 430
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4264
Practice Address - Country:US
Practice Address - Phone:281-378-3355
Practice Address - Fax:281-378-3356
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103010208600000X
TXR8389208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBE630ZMedicare PIN