Provider Demographics
NPI:1346491941
Name:DINA KANER, M.D., S.C.
Entity type:Organization
Organization Name:DINA KANER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-632-0600
Mailing Address - Street 1:3385 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7702
Mailing Address - Country:US
Mailing Address - Phone:847-632-0600
Mailing Address - Fax:847-632-0604
Practice Address - Street 1:3385 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7702
Practice Address - Country:US
Practice Address - Phone:847-632-0600
Practice Address - Fax:847-632-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092768Medicaid