Provider Demographics
NPI:1710918057
Name:KANE, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:KANE
Suffix:
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 1:477 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:443-821-3674
Mailing Address - Fax:443-821-3677
Practice Address - Street 1:477 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:443-821-3674
Practice Address - Fax:443-821-3677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445150208800000X
MDD47490208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA363562OtherHIGHMARK BS
Y532-0001OtherCAREFIRST
PAU051-0044OtherCAREFIRST
MD4921003Medicaid
MD492100300Medicaid
PAU051-0044OtherCAREFIRST