Provider Demographics
NPI:1538363171
Name:KITAGAWA, KEVIN M (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:KITAGAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:SUITE 439
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6635
Mailing Address - Country:US
Mailing Address - Phone:207-941-8200
Mailing Address - Fax:207-990-4848
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 439
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6635
Practice Address - Country:US
Practice Address - Phone:207-941-8200
Practice Address - Fax:207-990-4848
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI4754207ZP0102X
MEMD19249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology