Healthcare Provider Details

I. General information

NPI: 1164918710
Provider Name (Legal Business Name): DANIEL JONATHAN KAGEDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 09/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRINITY HEALTH IHA MEDICAL GROUP HEPATOBILIARY & PANCEA 44555 WOODWARD AVE STE 507
PONTIAC MI
48341
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR. SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 248-287-7820
  • Fax:
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number98114
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301517507
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: