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General NPI Number Information
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NPI Number | 1538363171
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Entity Type | Individual
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Provider Name | KEVIN M KITAGAWA MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 417 STATE ST SUITE 439
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City | BANGOR
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State | ME
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Zip | 04401-6635
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Country | US
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Telephone | 207-941-8200
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Fax | 207-990-4848
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Provider Business Mailing Address
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Address Line | 417 STATE ST SUITE 439
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City | BANGOR
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State | ME
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Zip | 04401-6635
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Country | US
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Telephone | 207-941-8200
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Fax | 207-990-4848
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 4754
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD19249
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License Number State | ME
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