Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 4301052976 | MI |
NPI | 1477599207 |
---|---|
Provider Name | Dr. Kevin R. Kane |
First Address | Grand Rapids, MI 49503-4656 |
Second Address | Chicago, IL 60689-5335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 24/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3382285 | (05) | MI |
F64658 | (02) | MI |