MEDICARE: DR. JANIE L CANNER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036109328	IL

General Provider Information

NPI Number	:	1578548483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANIE L CANNER D.O.

Provider Business Mailing Address
First Line	:	2007 95TH ST
Second Line	:	LOWER LEVEL, SUITE A
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8459
Country	:	US
Telephone Number	:	630-848-1700
Fax Number	:	630-848-1718

Provider Business Practice Location Address
First Line	:	2007 95TH ST
Second Line	:	LOWER LEVEL, SUITE A
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8459
Country	:	US
Telephone Number	:	630-848-1700
Fax Number	:	630-848-1718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	05/23/2012

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