Basic Information
| Provider Information | |||||||||
| NPI: | 1144428681 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ERIC M. KAGEL M.D. MEDICAL CORP | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2505 SAMARITAN DR | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951244006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083583555 | ||||||||
| FaxNumber: | 4083583505 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 SAMARITAN DR | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951244006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083583555 | ||||||||
| FaxNumber: | 4083583505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | KAGEL | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | MOSS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4083583555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 00A727231 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.