Provider Demographics
NPI:1922107838
Name:CANEVA, DARYL SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:SCOTT
Last Name:CANEVA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N HAMMES AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6677
Mailing Address - Country:US
Mailing Address - Phone:815-741-0791
Mailing Address - Fax:815-741-9576
Practice Address - Street 1:200 N HAMMES AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6677
Practice Address - Country:US
Practice Address - Phone:815-741-0791
Practice Address - Fax:815-741-9576
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP15844Medicare PIN
ILP15847Medicare PIN
ILT37461Medicare UPIN
IL0528550002Medicare NSC