Basic Information
Provider Information | |||||||||
NPI: | 1114009164 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KANE | ||||||||
FirstName: | DONALD | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5700 E PIMA STREET | ||||||||
Address2: | SUITE B | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 857125601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5203822819 | ||||||||
FaxNumber: | 5203822832 | ||||||||
Practice Location | |||||||||
Address1: | 5301 E GRANT ROAD | ||||||||
Address2: | TUCSON MEDICAL CENTER EMERGENCY DEPARTMENT | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 857122805 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5203241922 | ||||||||
FaxNumber: | 5203241088 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 3323 | AZ | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
ID | Type | State | Issuer | Description | 571936-07 | 05 | AZ |   | MEDICAID | 571936 | 01 | AZ | AHCCCS | OTHER |