Provider Demographics
NPI:1588660526
Name:KEGAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 602381
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2381
Mailing Address - Country:US
Mailing Address - Phone:828-349-6611
Mailing Address - Fax:828-349-6615
Practice Address - Street 1:55 MEDICAL PARK DR
Practice Address - Street 2:STE 108
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-2651
Practice Address - Country:US
Practice Address - Phone:828-349-6611
Practice Address - Fax:828-349-6615
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200300052207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012074AMedicare PIN
NCE52031Medicare UPIN
NC89133CEMedicaid
NC2012074Medicare ID - Type Unspecified