MEDICARE: MATTHEW DEAN HAGEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036100105	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376540930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DEAN HAGEMAN MD

Provider Business Mailing Address
First Line	:	130 LINCOLN PLACE CT STE 130
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5884
Country	:	US
Telephone Number	:	618-257-1297
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 LINCOLN PLACE CT STE 130
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5884
Country	:	US
Telephone Number	:	618-257-1297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	02/19/2021

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