Provider Demographics
NPI:1710086657
Name:MCGAHARAN, KEVIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MCGAHARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53067
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0326
Mailing Address - Country:US
Mailing Address - Phone:941-921-3500
Mailing Address - Fax:941-921-3300
Practice Address - Street 1:5580 BEE RIDGE RD
Practice Address - Street 2:BUILDING B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1505
Practice Address - Country:US
Practice Address - Phone:941-921-3500
Practice Address - Fax:941-921-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41965208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0673579Medicaid
FL201139OtherAMERIGROUP
FL58385OtherBCBS
FL0673579Medicaid