Healthcare Provider Details

I. General information

NPI: 1063555449
Provider Name (Legal Business Name): MICHAEL E CAGAN LIC. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SEASIDE WELLNESS CENTER 213 PAULINE ST
WINTHROP MA
02152
US

IV. Provider business mailing address

69 ELM ST
WESTWOOD MA
02090-1507
US

V. Phone/Fax

Practice location:
  • Phone: 781-458-6304
  • Fax:
Mailing address:
  • Phone: 781-458-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number474
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: