MEDICARE: DR. HEIDI C HAGEN DPM

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	213ES0131X	Foot Surgery Podiatrist	12-00287	KS
2	213ES0131X	Foot Surgery Podiatrist	000627	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24240033	OTHER	MO	BLUE CROSS BLUE SHIELD MO
2	400719	OTHER	MO	BLUE SHIELD TOPEKA
3	400719	OTHER	KS	BLUE SHIELD TOPEKA
4	24240023	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538120282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI C HAGEN DPM

Provider Business Mailing Address
First Line	:	9119 W 74TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-2229
Country	:	US
Telephone Number	:	913-677-3600
Fax Number	:	913-432-7624

Provider Business Practice Location Address
First Line	:	1956 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-228-6995
Fax Number	:	816-228-8672

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	05/19/2008

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Directions to “ DR. HEIDI C HAGEN DPM” Practice Location

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