Provider Demographics
NPI:1477599207
Name:KANE, KEVIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:350 LAFAYETTE AVE SE
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4656
Mailing Address - Country:US
Mailing Address - Phone:616-456-8515
Mailing Address - Fax:616-456-8208
Practice Address - Street 1:3565 MOMENTUM PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60689-5335
Practice Address - Country:US
Practice Address - Phone:616-456-8515
Practice Address - Fax:616-456-8208
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052976207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3382285Medicaid
MIF64658Medicare UPIN
MIM5160007Medicare PIN