Basic Information
Provider Information
NPI: 1285924290
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KANE
FirstName: ARI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6102
Address2:  
City: NOVATO
State: CA
PostalCode: 949486102
CountryCode: US
TelephoneNumber: 4158843418
FaxNumber: 4158833406
Practice Location
Address1: 180 ROWLAND WAY
Address2:  
City: NOVATO
State: CA
PostalCode: 949455009
CountryCode: US
TelephoneNumber: 4152091500
FaxNumber: 4152091501
Other Information
ProviderEnumerationDate: 04/11/2011
LastUpdateDate: 09/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085N0700XA141646CAN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085R0202XA141646CAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


Home