Provider Demographics
NPI:1245466440
Name:KANE, JUSTIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
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:PO BOX 207674
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:972-294-3343
Practice Address - Street 1:5575 WARREN PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4063
Practice Address - Country:US
Practice Address - Phone:972-591-6468
Practice Address - Fax:972-591-6469
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3027207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery