Provider Demographics
NPI:1952360794
Name:KANE, MAUREEN AGATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:AGATHA
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2534
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:651-726-7256
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2534
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:651-726-7256
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN24311207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31446400Medicaid
WI31446400Medicaid