Healthcare Provider Details

I. General information

NPI: 1710921382
Provider Name (Legal Business Name): JOHN F KANE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 N CENTRAL AVE
CHICAGO IL
60634-2732
US

IV. Provider business mailing address

3936 N CENTRAL AVE
CHICAGO IL
60634-2732
US

V. Phone/Fax

Practice location:
  • Phone: 773-685-3933
  • Fax: 773-685-2416
Mailing address:
  • Phone: 773-685-3933
  • Fax: 773-685-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238.000475
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: