Provider Demographics
NPI:1730151267
Name:KAGAN, ABBOTT II (MD)
Entity type:Individual
Prefix:DR
First Name:ABBOTT
Middle Name:
Last Name:KAGAN
Suffix:II
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 1:18741 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-3643
Mailing Address - Country:US
Mailing Address - Phone:239-851-2449
Mailing Address - Fax:855-710-4433
Practice Address - Street 1:18741 S RIVER RD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:FL
Practice Address - Zip Code:33920-3643
Practice Address - Country:US
Practice Address - Phone:239-851-2449
Practice Address - Fax:855-710-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20746207XS0114X
FLME0020746207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36398YMedicare ID - Type Unspecified
FLD23552Medicare UPIN