Kanjo, Tadge M

Kanjo, Tadge M is an individual health care provider with primary practice located at 196 Arrowhead Dr Suite 6, Evanston WY 82930-8752. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Kanjo, Tadge M can be contacted via phone (307) 783-8398.

Contact Information

Primary practice address
196 Arrowhead Dr Suite 6 Evanston WY 82930-8752
Phone: (307) 783-8398
Fax: (307) 783-8399
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 41467-020 Wisconsin
Allopathic & Osteopathic Physicians / Surgery 208600000X 41467-020 Wisconsin
Allopathic & Osteopathic Physicians / Surgery 208600000X TL1909 Wyoming

Profile Details

NPI number 1710970058
LBN Legal business name Kanjo, Tadge M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2005
Last updated Sep 12th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710970058 NPPES
Wisconsin MEDICAID 33338100

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