Healthcare Provider Details

I. General information

NPI: 1497748131
Provider Name (Legal Business Name): LEO KANEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2349
US

IV. Provider business mailing address

800 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2349
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-5075
  • Fax: 847-618-3259
Mailing address:
  • Phone: 847-618-5075
  • Fax: 847-618-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036102811
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036102811
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: