Provider Demographics
NPI:1528475936
Name:NAGAMA, MIKAL
Entity type:Individual
Prefix:
First Name:MIKAL
Middle Name:
Last Name:NAGAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 REMINGTON PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8599
Mailing Address - Country:US
Mailing Address - Phone:816-668-3105
Mailing Address - Fax:
Practice Address - Street 1:414 REMINGTON PLAZA CT
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8599
Practice Address - Country:US
Practice Address - Phone:816-668-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide