Provider Demographics
NPI:1841356573
Name:KAGAN, ROBERT SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:KAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-952-9333
Mailing Address - Fax:847-952-9351
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-952-9333
Practice Address - Fax:847-952-9351
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36068026208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE14268Medicare UPIN