Provider Demographics
NPI:1770720641
Name:KEAGLE MEDICAL, INC.
Entity type:Organization
Organization Name:KEAGLE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NEWMAN
Authorized Official - Last Name:KEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-505-6012
Mailing Address - Street 1:2614 ARTHUR ST STE C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3990
Mailing Address - Country:US
Mailing Address - Phone:213-250-1300
Mailing Address - Fax:
Practice Address - Street 1:2614 ARTHUR ST STE C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3990
Practice Address - Country:US
Practice Address - Phone:213-250-1300
Practice Address - Fax:213-559-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA647732086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty