Provider Demographics
NPI:1710943097
Name:KANER, DINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:KANER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092768Medicaid
IL036092768Medicaid