Provider Demographics
NPI:1871503938
Name:KANE, KAREN R (MD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:574 PRAIRIE CENTER DR STE 135
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7955
Mailing Address - Country:US
Mailing Address - Phone:651-639-9150
Mailing Address - Fax:651-639-9153
Practice Address - Street 1:3601 MINNESOTA DR
Practice Address - Street 2:SUITE 600
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5281
Practice Address - Country:US
Practice Address - Phone:952-851-8200
Practice Address - Fax:952-851-8219
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN27150207R00000X, 2083X0100X
MN271052081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN213788700Medicaid
MN213788700Medicaid