Provider Demographics
NPI:1073579520
Name:KANE, GEORGIA JEANE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:JEANE
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:JEANE
Other - Last Name:LALIOTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:127
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-7633
Mailing Address - Fax:813-978-5988
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 127
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7633
Practice Address - Fax:813-978-5988
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME942912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32370ZMedicare ID - Type Unspecified
I25069Medicare UPIN
FL2743507-00Medicare ID - Type Unspecified