Provider Demographics
NPI:1497748131
Name:KANEV, LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:KANEV
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 1:800 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2349
Mailing Address - Country:US
Mailing Address - Phone:847-618-5075
Mailing Address - Fax:847-618-3259
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-5075
Practice Address - Fax:847-618-3259
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36102811Medicaid
IL01627201OtherBCBS
IL036102811OtherSTATE LICENSE
IL01627201OtherBCBS
ILK46650Medicare PIN
IL36102811Medicaid
ILK46652Medicare PIN
P00066783Medicare ID - Type UnspecifiedRR