=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194914457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEO KANEV MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2007
-----------------------------------------------------
Last Update Date | 10/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 985 S BUFFALO GROVE RD
-----------------------------------------------------
City | BUFFALO GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60089-3702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-541-4878
-----------------------------------------------------
Fax | 847-520-0500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 985 S BUFFALO GROVE RD
-----------------------------------------------------
City | BUFFALO GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60089-3702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-541-4878
-----------------------------------------------------
Fax | 847-520-0500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. LEO KANEV
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-541-4878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------