Provider Demographics
NPI:1740204551
Name:KANE, MICHELLE CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:KANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4002
Mailing Address - Country:US
Mailing Address - Phone:856-341-8190
Mailing Address - Fax:856-881-2071
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4002
Practice Address - Country:US
Practice Address - Phone:856-341-8181
Practice Address - Fax:856-341-8180
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07785000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ125610Medicaid
NJ125610Medicaid