Provider Demographics
NPI:1700553344
Name:KANAN MEDICAL, LLC
Entity Type:Organization
Organization Name:KANAN MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-767-0009
Mailing Address - Street 1:460 E ALTAMONTE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4653
Mailing Address - Country:US
Mailing Address - Phone:407-767-0009
Mailing Address - Fax:407-767-0022
Practice Address - Street 1:2705 REBECCA LN STE A
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8336
Practice Address - Country:US
Practice Address - Phone:407-767-0009
Practice Address - Fax:407-767-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty