Basic Information
| Provider Information | |||||||||
| NPI: | 1396741674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 848 1ST AVE N | ||||||||
| Address2: | STE 330 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341026063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392638855 | ||||||||
| FaxNumber: | 2392630680 | ||||||||
| Practice Location | |||||||||
| Address1: | 848 1ST AVE N | ||||||||
| Address2: | STE 330 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341026063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392638855 | ||||||||
| FaxNumber: | 2392630680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/20/2006 | ||||||||
| NPIReactivationDate: | 04/05/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | ME0041439 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 067583100 | 05 | FL | MEDICAID |