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NPI Code Detail

MEDICARE: CANAAN KERR MD

MEDICARE: CANAAN KERR MD
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
1207R00000XInternal Medicine Physician125.088630IL

General Provider Information

NPI Number : 1114712429
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANAAN KERR MD
Provider Business Mailing Address
First Line : 3249 OAK PARK AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-0715
Country : US
Telephone Number : 708-783-3425
Fax Number :
Provider Business Practice Location Address
First Line : 3249 OAK PARK AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-0715
Country : US
Telephone Number : 314-619-4039
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2025
Last Update Date : 06/19/2026

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