Individual
KATHLEEN M FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVENUE, CLEVELAND, OH 44106
(216) 844-7700
(216) 286-6299
Mailing address
3605 WARRENSVILLE CTR RD, MSC9152, SHAKER HTS, OH 44122
(216) 286-6299
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
35051175
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221255
UNISON
OH
01
—
000000525944
ANTHEM
OH
01
—
0607641
BCMH
OH
05
—
0607641
—
OH
01
—
363514
WELLCARE
OH
01
—
4052254
AETNA
OH
01
—
745904
BUCKEYE
OH
Enumeration date
05/31/2006
Last updated
06/12/2008
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