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General NPI Number Information
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NPI Number | 1902092554
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Entity Type | Organization
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Legal Business Name | CANEVA FOOT & ANKLE CLINIC, LTD.
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 200 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-6677
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Country | US
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Telephone | 815-741-0791
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Fax | 815-741-9576
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Provider Business Mailing Address
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Address Line | 200 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-6677
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Country | US
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Telephone | 815-741-0791
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Fax | 815-741-9576
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Authorized Official
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Title or Position | OWNER
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Name | DR. DARYL SCOTT CANEVA
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Credential | DPM
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Telephone | 815-741-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004255
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License Number State | IL
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