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1200 N Ashland Ave Ste 500, Chicago, IL 60622-8327 | |
(310) 779-3224 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Physician Assistant - Surgical |
Location | 1200 N Ashland Ave Ste 500, Chicago, Illinois |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1033959127 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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213ES0103X | Podiatrist - Foot & Ankle Surgery | (* (Not Available)) | Secondary |
363AS0400X | Physician Assistant - Surgical | (* (Not Available)) | Primary |
Provider Name | David B Kagan |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1992965768 PECOS PAC ID: 7517154792 Enrollment ID: I20240909003006 |
Mailing Address | Practice Location Address |
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100 E Huntington Dr Ste 203, Alhambra, CA 91801-1022 Ph: () - | 1200 N Ashland Ave Ste 500, Chicago, IL 60622-8327 Ph: (310) 779-3224 |