MEDICARE: DR. KIMBERLY HAGERMAN M.D.

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	207Q00000X	Family Medicine Physician	35076863	OH

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	:	1487650446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY HAGERMAN M.D.

Provider Business Mailing Address
First Line	:	128 DEPOT STREET
Second Line	:
City	:	WAUSEON
State	:	OH
Zip	:	43567-1164
Country	:	US
Telephone Number	:	419-335-0351
Fax Number	:	419-335-0397

Provider Business Practice Location Address
First Line	:	128 DEPOT ST
Second Line	:
City	:	WAUSEON
State	:	OH
Zip	:	43567-1305
Country	:	US
Telephone Number	:	419-335-0351
Fax Number	:	419-335-0397

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	06/10/2021

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