Provider Demographics
NPI:1356447205
Name:KEVIN M. KANE D.P.M. INC.
Entity Type:Organization
Organization Name:KEVIN M. KANE D.P.M. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-642-3668
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002425213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744196Medicaid
OH9366431Medicare PIN
OHDG1121Medicare PIN
OH4697800001Medicare NSC