MEDICARE: HAGERMAN FAMILY PHYSICIANS, INC

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	261QP2300X	Primary Care Clinic/Center	35082560	OH
2	261QP2300X	Primary Care Clinic/Center	35076863	OH

General Provider Information

NPI Number	:	1538266739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAGERMAN FAMILY PHYSICIANS, INC

Provider Business Mailing 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

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	:	OWNER
Name	:	DR. KIMBERLY L HAGERMAN
Credential	:	M.D.
Telephone Number	:	419-335-0351

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/16/2009

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