Individual
DR. KEVIN J FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
71 W 156TH ST, SUITE 308, HARVEY, IL 60426-4260
(708) 331-6617
(708) 331-7957
Mailing address
27702 NETWORK PL, CHICAGO, IL 60673-1277
(708) 862-7674
(708) 862-1781
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036068721
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036068721
—
IL
01
—
F400415105
MEDICARE
IL
Enumeration date
08/14/2006
Last updated
02/14/2019
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