Provider Demographics
NPI:1316995384
Name:KANER, JAY JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:JOSEPH
Last Name:KANER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:J
Other - Last Name:KANER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:39581 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4300
Mailing Address - Country:US
Mailing Address - Phone:586-286-2770
Mailing Address - Fax:586-286-9080
Practice Address - Street 1:39581 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4300
Practice Address - Country:US
Practice Address - Phone:586-286-2770
Practice Address - Fax:586-286-9080
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0069932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA74731Medicare UPIN
MI0M33600Medicare ID - Type Unspecified