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NPI Code Detail

MEDICARE: DR. MARY ARNDT HAGAN M.D.

MEDICARE: DR. MARY ARNDT HAGAN 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
1208000000XPediatrics Physician58575MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1501782OTHERWITOUCHPOINT
2WI01P1OTHERWIJOHN DEERE
312805OTHERWIDEAN
439080723696OTHERWIBLUE CROSS BLUE SHIELD
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659362077
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ARNDT HAGAN M.D.
Provider Business Mailing Address
First Line : 300 S BRUCE ST
Second Line : AVERA MARSHALL
City : MARSHALL
State : MN
Zip : 56258-1934
Country : US
Telephone Number : 507-537-9007
Fax Number : 507-537-2720
Provider Business Practice Location Address
First Line : 300 S BRUCE ST
Second Line : AVERA MARSHALL
City : MARSHALL
State : MN
Zip : 56258-1934
Country : US
Telephone Number : 507-537-9007
Fax Number : 507-537-2720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 03/09/2015

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