Provider Demographics
NPI:1023090354
Name:KANE, MARY GLORIA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GLORIA
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 1:33 W HIGGINS RD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9115
Mailing Address - Country:US
Mailing Address - Phone:847-426-4355
Mailing Address - Fax:847-426-0047
Practice Address - Street 1:33 W HIGGINS RD
Practice Address - Street 2:SUITE 820
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9115
Practice Address - Country:US
Practice Address - Phone:847-426-4355
Practice Address - Fax:847-426-0047
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03663318207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L83786Medicare ID - Type Unspecified
D15565Medicare UPIN