Provider Demographics
NPI:1437189842
Name:KANAREK, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KANAREK
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:RFD 4160
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-634-2090
Mailing Address - Fax:847-634-2140
Practice Address - Street 1:RFD 4160
Practice Address - Street 2:SUITE 304
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-634-2090
Practice Address - Fax:847-634-2140
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL004932170OtherBCBS PROVIDER #
IL204843OtherMEDICARE PROVIDER #
ILL96944Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
IL204843OtherMEDICARE PROVIDER #