Provider Demographics
NPI:1578548483
Name:CANNER, JANIE L (DO)
Entity Type:Individual
Prefix:DR
First Name:JANIE
Middle Name:L
Last Name:CANNER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2007 95TH ST
Mailing Address - Street 2:LOWER LEVEL, SUITE A
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8459
Mailing Address - Country:US
Mailing Address - Phone:630-848-1700
Mailing Address - Fax:630-848-1718
Practice Address - Street 1:2007 95TH ST
Practice Address - Street 2:LOWER LEVEL, SUITE A
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8459
Practice Address - Country:US
Practice Address - Phone:630-848-1700
Practice Address - Fax:630-848-1718
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036109328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI36312Medicare UPIN