Basic Information
| Provider Information | |||||||||
| NPI: | 1760483549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KADEL | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RONCEVERTE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249701334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046471175 | ||||||||
| FaxNumber: | 3046473006 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 N PACIFIC COAST HWY STE 2175 | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902455639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778783289 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 1938 | WV | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | 0102201488 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 20A13459 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 116787 | 01 | VA | ANTHEM | OTHER | 010080606 | 05 | VA | MEDICAID | 010080606 | 05 | WV | MEDICAID |