Provider Demographics
NPI:1801983408
Name:KANAREK, HENRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:KANAREK
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 1:32031 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9726
Mailing Address - Country:US
Mailing Address - Phone:913-451-8555
Mailing Address - Fax:
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-451-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSR4P09207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11282OtherCOVENTRY
19479074OtherBLUE CROSS
208020OtherUNITED HEALTHCARE
11282OtherPRINCIPAL
2494083OtherAETNA
30005015Medicare ID - Type UnspecifiedMEDICARE RR
0005459Medicare ID - Type Unspecified
19479074OtherBLUE CROSS