Basic Information
| Provider Information | |||||||||
| NPI: | 1700271012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANAL | ||||||||
| FirstName: | MANEESH | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 S MINNESOTA ST | ||||||||
| Address2: | |||||||||
| City: | CROOKSTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567161601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182819293 | ||||||||
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| Practice Location | |||||||||
| Address1: | 323 S MINNESOTA ST | ||||||||
| Address2: | |||||||||
| City: | CROOKSTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182819293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 63484 | MN | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | 63484 | MN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 63484 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.