Provider Demographics
NPI:1982867701
Name:KANE, WALTER BRUCE II (DO)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:BRUCE
Last Name:KANE
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29226 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2984
Mailing Address - Country:US
Mailing Address - Phone:248-851-5633
Mailing Address - Fax:248-851-5634
Practice Address - Street 1:1455 COLLINGSWOOD AVE
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5833
Practice Address - Country:US
Practice Address - Phone:248-851-5633
Practice Address - Fax:248-851-5634
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003071207X00000X
FLOS4124207X00000X
MI5101006877207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery