MEDICARE: DR. JAY JOSEPH KANER DO

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
1	2084N0400X	Neurology Physician	006993	MI

General Provider Information

NPI Number	:	1316995384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY JOSEPH KANER DO

Provider Business Mailing Address
First Line	:	39581 GARFIELD RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4300
Country	:	US
Telephone Number	:	586-286-2770
Fax Number	:	586-286-9080

Provider Business Practice Location Address
First Line	:	39581 GARFIELD RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4300
Country	:	US
Telephone Number	:	586-286-2770
Fax Number	:	586-286-9080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/30/2007

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