Provider Demographics
NPI:1598285207
Name:KANE, STEPHANIE (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12983 SOUTHERN BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9207
Mailing Address - Country:US
Mailing Address - Phone:561-203-9285
Mailing Address - Fax:561-576-0809
Practice Address - Street 1:12983 SOUTHERN BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9207
Practice Address - Country:US
Practice Address - Phone:561-203-9285
Practice Address - Fax:561-576-0809
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4168213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114223400Medicaid