Healthcare Provider Details

I. General information

NPI: 1750471900
Provider Name (Legal Business Name): PATRICIA KANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 N MOUNTAIN AVE
TUCSON AZ
85719-1938
US

IV. Provider business mailing address

6408 E TANQUE VERDE RD
TUCSON AZ
85715-3809
US

V. Phone/Fax

Practice location:
  • Phone: 520-882-5145
  • Fax: 520-882-7504
Mailing address:
  • Phone: 520-885-5558
  • Fax: 520-885-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number24619
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: