Provider Demographics
NPI:1508924267
Name:KAGAN, TATYANA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:KAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9933 LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3703
Mailing Address - Country:US
Mailing Address - Phone:847-626-0303
Mailing Address - Fax:847-626-0191
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3703
Practice Address - Country:US
Practice Address - Phone:847-626-0303
Practice Address - Fax:847-626-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102378173000000X
IL036-102378208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No173000000XOther Service ProvidersLegal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL542161791OtherTAX ID
ILH25538Medicare UPIN