Provider Demographics
NPI:1063555449
Name:CAGAN, MICHAEL E (LIC AC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:CAGAN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1507
Mailing Address - Country:US
Mailing Address - Phone:781-458-6304
Mailing Address - Fax:
Practice Address - Street 1:SEASIDE WELLNESS CENTER
Practice Address - Street 2:213 PAULINE ST
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152
Practice Address - Country:US
Practice Address - Phone:781-458-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA474171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist