Provider Demographics
NPI:1033102405
Name:KANE, KEVIN MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:KANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7393 BROADVIEW RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4444
Mailing Address - Country:US
Mailing Address - Phone:216-642-3668
Mailing Address - Fax:216-573-0769
Practice Address - Street 1:7393 BROADVIEW RD
Practice Address - Street 2:SUITE F
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-4444
Practice Address - Country:US
Practice Address - Phone:216-642-3668
Practice Address - Fax:216-573-0769
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002425213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000140028OtherANTHEM BCBS
OH104035OtherKAISER
OHP02425OtherSUMMACARE HEALTH PLAN
OH000000140028OtherUNICARE LIFE & HEALTH
OH0956265Medicaid
OH374325OtherWELLCARE OF OHIO
OH0956265Medicaid
OHP02425OtherSUMMACARE HEALTH PLAN
OH480034192Medicare PIN