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NPI Code Detail

MEDICARE: DR. JOANN CAROL KANIA DDS

MEDICARE: DR. JOANN CAROL KANIA DDS
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
1122300000XDentistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205827300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOANN CAROL KANIA DDS
Provider Business Mailing Address
First Line : 2322 N MAPLEWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-3129
Country : US
Telephone Number : 312-505-5987
Fax Number :
Provider Business Practice Location Address
First Line : 5137 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60651-2904
Country : US
Telephone Number : 773-378-4694
Fax Number : 773-378-1294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 07/09/2007

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