Provider Demographics
NPI:1043312606
Name:KANIN, HARRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:J
Last Name:KANIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4217
Mailing Address - Country:US
Mailing Address - Phone:414-461-9250
Mailing Address - Fax:414-461-3553
Practice Address - Street 1:2501 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4217
Practice Address - Country:US
Practice Address - Phone:414-461-9250
Practice Address - Fax:414-461-3553
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10361174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10361OtherLICENSE
WI30901900Medicaid
WIB84964Medicare UPIN
WI73335-0029Medicare ID - Type Unspecified