Individual
GLENN S. KANAMORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1717 S ORANGE AVE STE 100, NEMOURS CHILDRENS CLINIC, ORLANDO, ORLANDO, FL 32806-2946
(407) 650-7715
(407) 650-7124
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-4488
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
G65026
CA
207YP0228X
Pediatric Otolaryngology Physician
Primary
ME115604
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G650260
—
CA
Enumeration date
10/03/2006
Last updated
04/29/2013
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