MEDICARE: DR. MICHAEL J KEGAN M.D.

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	207RC0000X	Cardiovascular Disease Physician	200300052	NC
2	207R00000X	Internal Medicine Physician	200300052	NC

General Provider Information

NPI Number	:	1588660526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J KEGAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 602381
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2381
Country	:	US
Telephone Number	:	828-349-6611
Fax Number	:	828-349-6615

Provider Business Practice Location Address
First Line	:	55 MEDICAL PARK DR
Second Line	:	STE 108
City	:	FRANKLIN
State	:	NC
Zip	:	28734-2651
Country	:	US
Telephone Number	:	828-349-6611
Fax Number	:	828-349-6615

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/25/2016

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