Provider Demographics
NPI:1376842591
Name:KANU, TERATA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:TERATA
Middle Name:ANN
Last Name:KANU
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 1:2122 RUFE SNOW DR STE 132
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5691
Mailing Address - Country:US
Mailing Address - Phone:817-576-4050
Mailing Address - Fax:817-796-1422
Practice Address - Street 1:2122 RUFE SNOW DR STE 132
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5691
Practice Address - Country:US
Practice Address - Phone:817-576-4050
Practice Address - Fax:817-796-1422
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ60392083P0901X, 208VP0014X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine