Provider Demographics
NPI:1104888502
Name:CANER, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:CANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:185 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3010
Mailing Address - Country:US
Mailing Address - Phone:847-883-0077
Mailing Address - Fax:847-883-0078
Practice Address - Street 1:185 MILWAUKEE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3010
Practice Address - Country:US
Practice Address - Phone:847-883-0077
Practice Address - Fax:847-883-0078
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097308207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360973082Medicaid
IL04920125OtherBC/BS OF IL
IL04920125OtherBC/BS OF IL