Provider Demographics
NPI:1235230087
Name:ABBOTT KAGAN II, M.D., P.A.
Entity Type:Organization
Organization Name:ABBOTT KAGAN II, M.D., P.A.
Other - Org Name:A. KAGAN ORTHOPEDICS & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAUBENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-482-8788
Mailing Address - Street 1:8710 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-482-8788
Mailing Address - Fax:239-482-1566
Practice Address - Street 1:8710 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-482-8788
Practice Address - Fax:239-482-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0511200001Medicare NSC
FL406201440Medicare PIN
FL77144Medicare PIN