Provider Demographics
NPI:1508895194
Name:KANE, JOHN N JR (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:KANE
Suffix:JR
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 1:5025 TURNEY RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2530
Mailing Address - Country:US
Mailing Address - Phone:216-587-4141
Mailing Address - Fax:216-587-5491
Practice Address - Street 1:5025 TURNEY RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2530
Practice Address - Country:US
Practice Address - Phone:216-587-4141
Practice Address - Fax:216-587-5491
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001660213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128830OtherANTHEM
OH0269856Medicaid
OH341230100014OtherMEDICAL MUTUAL
OH480000262OtherRAILROAD MEDICARE
OH341230100014OtherMEDICAL MUTUAL
OH0269856Medicaid