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NPI Code Detail

MEDICARE: ADA A. KAGUMBA M.D.

MEDICARE: ADA A. KAGUMBA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician072381GA
2207V00000XObstetrics & Gynecology Physician036106906IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1202I163207OTHERGAMEDICARE PTAN

General Provider Information

NPI Number : 1356314728
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADA A. KAGUMBA M.D.
Provider Business Mailing Address
First Line : 1025 MAINE ST.
Second Line :
City : QUINCY
State : IL
Zip : 62301
Country : US
Telephone Number : 217-222-6550
Fax Number :
Provider Business Practice Location Address
First Line : 1118 HAMPSHIRE ST
Second Line :
City : QUINCY
State : IL
Zip : 62301-3027
Country : US
Telephone Number : 217-222-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 09/23/2016

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