Kancc Medical PLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

KANCC MEDICAL PLC

Doing business as

Kancc Medical

Practice address

17331 Mack Ave
Detroit, MI 48224-2250

Phone

(313) 473-8525

Fax

(313) 473-8521

NPI assigned

Jun 28, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peter R Nwoke, M.DNPI 1841398955

Title

Owner

Phone

(313) 473-8525

Specialties & licenses 4

Addresses

Other names 1

• Kancc Medical Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter R Nwoke, M.D

  • General Practice Physician
  • Detroit, MI
  • NPI 1841398955

  Family Medicine

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1437710563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 806464",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480806464",
            "telephone_number": "313-473-8525",
            "fax_number": "313-473-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17331 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242250",
            "telephone_number": "313-473-8525",
            "fax_number": "313-473-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANCC MEDICAL PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-28",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "NWOKE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-473-8525",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kancc Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alishba Kamran
• Wasih Kamran, MD
• Kinaan Kana, DDS
• Lulia Ayman Kana
• Haissam A Kanaan, DDS, FRCD(C)
• Watcharoot Kanchongkittiphon
• Srishti Kanda, M.D.
• Mahathi Kandala, MD
• Savannah Kandalaft, MD
• Nicole Kane

• General Practice Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.