Provider Demographics
NPI:1487671939
Name:KANE, ALEX A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:A
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 INWOOD RD
Mailing Address - Street 2:DEPARTMENT OF PLASTIC SURGERY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9132
Mailing Address - Country:US
Mailing Address - Phone:214-456-8671
Mailing Address - Fax:214-456-7278
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-8671
Practice Address - Fax:214-456-8881
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7552208200000X, 2082S0099X, 2086S0120X, 2086S0122X, 2086S0127X
MO1063132082S0099X, 2086S0120X, 2086S0122X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204880207Medicaid
TXTXB114605OtherMEDICARE PTAN
TXTXB114605OtherMEDICARE PTAN
IL$$$$$$$$$Medicaid
TXTXB114605OtherMEDICARE PTAN
037010543Medicare PIN