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General NPI Number Information
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NPI Number | 1730238890
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Entity Type | Organization
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Legal Business Name | KAGEN DERMATOLOGY CLINIC SC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 100 W LAWRENCE ST SUITE 409
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City | APPLETON
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State | WI
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Zip | 54911-5773
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Country | US
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Telephone | 920-733-5138
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Fax | 920-733-3759
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Provider Business Mailing Address
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Address Line | 100 W LAWRENCE ST SUITE 409
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City | APPLETON
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State | WI
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Zip | 54911-5773
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Country | US
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Telephone | 920-733-5138
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Fax | 920-733-3759
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES NORMAN KAGEN
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Credential | M.D.
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Telephone | 920-733-5138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24388
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License Number State | WI
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