Provider Demographics
NPI:1144428681
Name:ERIC M. KAGEL M.D. MEDICAL CORP
Entity Type:Organization
Organization Name:ERIC M. KAGEL M.D. MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MOSS
Authorized Official - Last Name:KAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-3555
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-358-3555
Mailing Address - Fax:408-358-3505
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-358-3555
Practice Address - Fax:408-358-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A727231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5605400001Medicare NSC
CAZZZ27783ZMedicare PIN
CAF92728Medicare UPIN