Healthcare Provider Details

I. General information

NPI: 1851369714
Provider Name (Legal Business Name): RICHARD JEFFREY KAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 BURNET AVENUE
CINCINNATI OH
45229-3095
US

IV. Provider business mailing address

PO BOX 8500 LOCK BOX #8302 SHRINERS HOSPITAL FOR CHILDREN
PHILADELPHIA PA
19178-8302
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-6206
  • Fax: 513-872-6396
Mailing address:
  • Phone: 813-281-8487
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-056534
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number35-056534
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: