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 1:5 S LEWIS PLZ
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2944
Mailing Address - Country:US
Mailing Address - Phone:864-242-4122
Mailing Address - Fax:877-893-3769
Practice Address - Street 1:5 S LEWIS PLZ
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2944
Practice Address - Country:US
Practice Address - Phone:864-242-4122
Practice Address - Fax:877-893-3769
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151010834207R00000X
MI5101024097207R00000X
SCDO83506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine