Provider Demographics
NPI:1053306969
Name:KANNER, STEVEN LEE (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:KANNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 45TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2031
Mailing Address - Country:US
Mailing Address - Phone:561-863-8301
Mailing Address - Fax:561-459-1712
Practice Address - Street 1:2051 45TH ST STE 303
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2031
Practice Address - Country:US
Practice Address - Phone:561-863-8301
Practice Address - Fax:615-459-1712
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL054485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060686300Medicaid
D60652Medicare UPIN
82499Medicare ID - Type Unspecified