Kevin J Fagan, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

036068721 Issued in IL

Practice address

71 W 156TH St
Suite 308
Harvey, IL 60426-4260

Phone

(708) 331-6617

Fax

(708) 331-7957

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550102400000",
    "number": "1427061068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27702 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731277",
            "telephone_number": "708-862-7674",
            "fax_number": "708-862-1781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 W 156TH ST",
            "address_2": "SUITE 308",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604264260",
            "telephone_number": "708-331-6617",
            "fax_number": "708-331-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "KEVIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2019-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036068721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "F400415105",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036068721",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ecneret Family Services - NFP, Inc.
• Helene B Elias, PA
• Darryl Chauncey English I, COTA/L
• Barbara A Enns, OTR./L
• Shane Exner, PMHNP-BC
• Tajiddin Faisal
• Family Association Plus
• Family Christian Health Center
• Family Christian Health Center
• Family Christian Health Center

• Neurology Physician in Harvey, IL
• Providers in Harvey, IL by specialty
• Neurology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.