Provider Demographics
NPI:1528005535
Name:KANE, JON P (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:P
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN424172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54G10KAOtherBLUE CROSS
MN141760OtherUCARE
MN297G2KAOtherBLUE CROSS
WI34507700Medicaid
MN560099600Medicaid
MN300127405OtherRAILROAD MEDICARE MN
MNHP34301OtherHEALTHPARTNERS
MN1030034OtherPREFERRED ONE
MN1538048OtherAMERICA'S PPO
MN9214824OtherDAKOTA CARE
MN141760OtherUCARE
MN300127405OtherRAILROAD MEDICARE MN
MN1030034OtherPREFERRED ONE
MN9214824OtherDAKOTA CARE
MN54G10KAOtherBLUE CROSS