Provider Demographics
NPI:1871770834
Name:KANE, KHADIDJATOU (MD)
Entity type:Individual
Prefix:
First Name:KHADIDJATOU
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 E PEARSON ST
Mailing Address - Street 2:APT 1612
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2577
Mailing Address - Country:US
Mailing Address - Phone:312-479-7232
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:SUITE 3-150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine