Provider Demographics
NPI:1407881576
Name:KANAR, COLIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:LEE
Last Name:KANAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112108
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0136
Mailing Address - Country:US
Mailing Address - Phone:239-593-0918
Mailing Address - Fax:239-593-0927
Practice Address - Street 1:11983 TAMIAMI TRL N
Practice Address - Street 2:SUITE 100D
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1603
Practice Address - Country:US
Practice Address - Phone:239-593-0918
Practice Address - Fax:239-593-0927
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00697602081P2900X, 2081S0010X
FLME69760208100000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379550100Medicaid
FLF85055Medicare UPIN
FL28517WMedicare PIN