Provider Demographics
NPI:1770843260
Name:THE KAGEN ALLERGY CLINIC SC
Entity Type:Organization
Organization Name:THE KAGEN ALLERGY CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-739-9100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22210-20207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty