MEDICARE: ED KANE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	227.007465	IL

General Provider Information

NPI Number	:	1700273562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ED KANE LMT

Provider Business Mailing Address
First Line	:	1237 W FOSTER AVE
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60640-2206
Country	:	US
Telephone Number	:	773-818-5232
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7431
Country	:	US
Telephone Number	:	312-235-6773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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Directions to “ ED KANE LMT” Practice Location

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