Provider Demographics
NPI:1720282593
Name:KANE, KATHERINE YVONNE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:YVONNE
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-927-0456
Mailing Address - Fax:817-927-4323
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-927-0456
Practice Address - Fax:817-927-4323
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN57562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284128002OtherCSHCN MEDICAID
TX284128003OtherOUT OF COUNTY MEDICAID
TX284128001Medicaid
TXP00975530OtherRAILROAD MEDICARE