Provider Demographics
NPI:1255390985
Name:KAGEN, MARK H (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:KAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15051 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-437-8810
Mailing Address - Fax:239-437-8875
Practice Address - Street 1:7331 GLADIOLUS DRIVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-437-8810
Practice Address - Fax:239-437-8875
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93913207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI41816Medicare UPIN
FL28650XMedicare PIN
FL99529AMedicare ID - Type Unspecified