Provider Demographics
NPI:1841204062
Name:KANE, MARTIN STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:STANLEY
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 1:220 N WESTMONTE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3310
Mailing Address - Country:US
Mailing Address - Phone:407-862-5707
Mailing Address - Fax:407-862-5707
Practice Address - Street 1:220 N WESTMONTE DR
Practice Address - Street 2:SUITE E
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3310
Practice Address - Country:US
Practice Address - Phone:407-862-5707
Practice Address - Fax:407-862-5707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00409092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55174Medicare UPIN
FL47768AMedicare ID - Type Unspecified