1033102405 NPI number — DR. KEVIN MICHAEL KANE D.P.M.

Table of content: DR. KEVIN MICHAEL KANE D.P.M. (NPI 1033102405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033102405 NPI number — DR. KEVIN MICHAEL KANE D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANE
Provider First Name:
KEVIN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033102405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7393 BROADVIEW RD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
SEVEN HILLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-4444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-642-3668
Provider Business Mailing Address Fax Number:
216-573-0769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7393 BROADVIEW RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SEVEN HILLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-4444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-642-3668
Provider Business Practice Location Address Fax Number:
216-573-0769
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  36002425 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000140028 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 104035 . This is a "KAISER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P02425 . This is a "SUMMACARE HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000140028 . This is a "UNICARE LIFE & HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0956265 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374325 . This is a "WELLCARE OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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