Provider Demographics
NPI:1235175589
Name:KAGEN, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:KAGEN
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 1:100 W LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5773
Mailing Address - Country:US
Mailing Address - Phone:920-739-9100
Mailing Address - Fax:920-739-8779
Practice Address - Street 1:100 W LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5773
Practice Address - Country:US
Practice Address - Phone:920-739-9100
Practice Address - Fax:920-739-8779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22210-020207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30392500Medicaid
WI45137Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
WI22118Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
WI30392500Medicaid
WI71131Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION