Provider Demographics
NPI:1194925677
Name:ROBERT S. KAGAN, M.D. SC
Entity type:Organization
Organization Name:ROBERT S. KAGAN, M.D. SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-952-9333
Mailing Address - Street 1:810 BIESTERFIELD ROAD
Mailing Address - Street 2:SUITE #302
Mailing Address - City:ELK GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7318
Mailing Address - Country:US
Mailing Address - Phone:847-952-9333
Mailing Address - Fax:
Practice Address - Street 1:810 BIESTERFIELD ROAD
Practice Address - Street 2:SUITE #302
Practice Address - City:ELK GROVE
Practice Address - State:IL
Practice Address - Zip Code:60007-7318
Practice Address - Country:US
Practice Address - Phone:847-952-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36068026208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL556860Medicare PIN