Basic Information
| Provider Information | |||||||||
| NPI: | 1881955292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | P | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4880 CENTURY PLAZA RD | ||||||||
| Address2: | STE 265 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462545471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172162700 | ||||||||
| FaxNumber: | 3172162777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2012 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02004627A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | PO1516616 | 01 | IN | RAILROAD MEDICARE | OTHER | 201290390 | 05 | IN | MEDICAID |