Provider Demographics
NPI:1790728004
Name:KANE, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
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 1:4855 CAMP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-646-1084
Mailing Address - Fax:716-646-0763
Practice Address - Street 1:4855 CAMP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-646-1084
Practice Address - Fax:716-646-0763
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002273045Medicaid
NY405029OtherWELLCARE
NYCC8392Medicare PIN
NY002273045Medicaid
DD8671Medicare PIN
NY405029OtherWELLCARE