Basic Information
| Provider Information | |||||||||
| NPI: | 1861440356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARAGINE | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | PHILIP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843225 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086331234 | ||||||||
| FaxNumber: | 7083427100 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 S MOUNT AUBURN RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733315487 | ||||||||
| FaxNumber: | 5733315488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 2009027530 | MO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 2085N0700X | 2009027530 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 000000643993 | 01 | ANTHEM BC/BS | OTHER | 1861440356 | 05 | IL | MEDICAID | 170727 | 01 | HEALTH ALLIANCE | OTHER | 769930 | 01 | HEALTHLINK | OTHER | 1861440356 | 01 | TRIWEST | OTHER | 2546605 | 05 | OH | MEDICAID | 1861440356 | 05 | MO | MEDICAID |