Healthcare Provider Details

I. General information

NPI: 1376524769
Provider Name (Legal Business Name): MICHAEL ALOYSIUS KANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MASSACHUSETTS AVE MIT MEDICAL DEPARTMENT
CAMBRIDGE MA
02139-4301
US

IV. Provider business mailing address

77 MASSACHUSETTS AVE E23-395
CAMBRIDGE MA
02139-4301
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-7825
  • Fax:
Mailing address:
  • Phone: 617-253-4988
  • Fax: 617-253-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31534
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number31534
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: