Provider Demographics
NPI:1720089451
Name:KANADY, KIRK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:EDWARD
Last Name:KANADY
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:PO BOX 8399
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8399
Mailing Address - Country:US
Mailing Address - Phone:281-364-1707
Mailing Address - Fax:281-364-0028
Practice Address - Street 1:25511 BUDDE RD
Practice Address - Street 2:SUITE 1201
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2080
Practice Address - Country:US
Practice Address - Phone:281-364-1707
Practice Address - Fax:281-364-0028
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK18492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00147937OtherRR MEDICARE PTAN FOR GRP
TX0303042-05Medicaid
TXP00142763OtherRR MEDICARE FOR GRP PTAN
TX8499B0OtherMEDICARE
TX92004577OtherRR MEDICARE PTAN
TXP00230852OtherRR MEDICARE PTAN
TX0303042-06Medicaid
TX00Z337Medicare PIN
TXP00147937OtherRR MEDICARE PTAN FOR GRP
TX030304203Medicaid