Provider Demographics
NPI:1114011681
Name:MACADAEG, KEVIN E (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:MACADAEG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-2321
Practice Address - Street 1:13225 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5480
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-228-2321
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040591A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000338385OtherANTHEM PROVIDER NUMBER
IN000000338385OtherUNICARE PROVIDER NUMBER
IN9450316OtherCIGNA PROVIDER NUMBER
IN366735000OtherUS DEPT. OF LABOR
IN000000016705OtherM-PLAN PROVIDER NUMBER
IN050086502OtherMEDICARE RAIL ROAD
IN366735000OtherUS POSTAL SERVICE WORKERS
F03107Medicare UPIN
IN000000338385OtherUNICARE PROVIDER NUMBER