Provider Demographics
NPI:1982691713
Name:KANE, PAMELA B (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:B
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 505443
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5443
Mailing Address - Country:US
Mailing Address - Phone:314-454-6444
Mailing Address - Fax:314-454-6445
Practice Address - Street 1:13001 N OUTER 40 RD
Practice Address - Street 2:STE 340
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5941
Practice Address - Country:US
Practice Address - Phone:314-454-6444
Practice Address - Fax:314-454-6445
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO102795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200037986Medicaid
DK3555666OtherDEA