Healthcare Provider Details

I. General information

NPI: 1306405576
Provider Name (Legal Business Name): LUCAS KANE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 TUSCALOOSA AVE SW
BIRMINGHAM AL
35211-1948
US

IV. Provider business mailing address

1308 TUSCALOOSA AVE SW
BIRMINGHAM AL
35211-1948
US

V. Phone/Fax

Practice location:
  • Phone: 205-679-6325
  • Fax:
Mailing address:
  • Phone: 205-679-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.2745
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: