Healthcare Provider Details

I. General information

NPI: 1730272659
Provider Name (Legal Business Name): MICHAEL E CAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 BASICH BLVD
ABERDEEN WA
98520-1066
US

IV. Provider business mailing address

1108 BASICH BLVD
ABERDEEN WA
98520-1066
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-0400
  • Fax: 360-533-5633
Mailing address:
  • Phone: 360-533-0400
  • Fax: 360-533-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00013847
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: