Provider Demographics
NPI:1285136911
Name:KAYANAN, DANILO RIVERA JR
Entity type:Individual
Prefix:
First Name:DANILO
Middle Name:RIVERA
Last Name:KAYANAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-9320
Mailing Address - Country:US
Mailing Address - Phone:309-966-5098
Mailing Address - Fax:
Practice Address - Street 1:125 S MORGAN
Practice Address - Street 2:STREET
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681
Practice Address - Country:US
Practice Address - Phone:217-883-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21365208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK55017677298OtherDMV