Individual
TADGE M KANJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
196 ARROWHEAD DR, SUITE 6, EVANSTON, WY 82930-8752
(307) 783-8398
(307) 783-8399
Mailing address
196 ARROWHEAD DR, SUITE 6, EVANSTON, WY 82930-8752
(307) 783-8398
(307) 783-8399
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
41467-020
WI
208600000X
Surgery Physician
41467-020
WI
208600000X
Surgery Physician
Primary
TL1909
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33338100
—
WI
Enumeration date
08/23/2005
Last updated
09/12/2012
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