Healthcare Provider Details

I. General information

NPI: 1114132602
Provider Name (Legal Business Name): THOMAS KANE D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 ORCHARD LAKE RD SUITE 302
WEST BLOOMFIELD MI
48322-4515
US

IV. Provider business mailing address

6960 ORCHARD LAKE RD SUITE 302
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-539-7890
  • Fax:
Mailing address:
  • Phone: 248-539-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number010756
License Number StateMI

VIII. Authorized Official

Name: THOMAS P KANE
Title or Position: DOCTOR OF PSYCHIATRY
Credential: D.O.
Phone: 248-539-7890