Provider Demographics
NPI:1710090469
Name:KANE, JAMES M JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:KANE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:616-897-0995
Mailing Address - Fax:616-897-0986
Practice Address - Street 1:250 CHERRY
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-752-6218
Practice Address - Fax:616-774-8960
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010515212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3121215Medicaid
MI0D11351OtherBCBSM
MI3121215Medicaid
MI3121215Medicaid