Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 22210-020 | WI |
NPI | 1235175589 |
---|---|
Provider Name | Steven L Kagen |
First Address | Appleton, WI 54911-5773 |
Second Address | Appleton, WI 54911-5773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 11/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30392500 | (05) | WI |
B53967 | (02) |