Healthcare Provider Details

I. General information

NPI: 1689495764
Provider Name (Legal Business Name): JOHN C KAGAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 11/19/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO RIO ABAJO CARRETERA 3 KM.HM 78.1
HUMACAO PR
00791
US

IV. Provider business mailing address

295 PALMAS INN WAY STE 6
HUMACAO PR
00791-6129
US

V. Phone/Fax

Practice location:
  • Phone: 239-229-8830
  • Fax:
Mailing address:
  • Phone: 239-229-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN CURRY KAGAN
Title or Position: PRESIDENT
Credential: MD
Phone: 239-229-8830