Provider Demographics
NPI:1770076168
Name:KANE, ERIC DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DOUGLAS
Last Name:KANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1109
Mailing Address - Country:US
Mailing Address - Phone:269-792-2249
Mailing Address - Fax:269-792-6121
Practice Address - Street 1:425 E ELM ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1109
Practice Address - Country:US
Practice Address - Phone:269-792-2249
Practice Address - Fax:269-792-6121
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315254798207R00000X
MI5101025666207R00000X
SCDO83506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine