1871903864 NPI number — MICHAEL H. KANE, M.D., LLC

Table of content: (NPI 1871903864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871903864 NPI number — MICHAEL H. KANE, M.D., LLC

Organization/Personal Information

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

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:
1871903864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
688 POOLE RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-6179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-821-3674
Provider Business Mailing Address Fax Number:
443-821-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
688 POOLE RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-6179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-821-3674
Provider Business Practice Location Address Fax Number:
443-821-3677
Provider Enumeration Date:
04/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KANE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HARVEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
443-821-3674

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25802ZEA5 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 225138 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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