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NPI Code Detail

MEDICARE: JONATHAN MICHAEL HAGEDORN M.D.

MEDICARE: JONATHAN MICHAEL HAGEDORN 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
1207L00000XAnesthesiology Physician63321MN
2208VP0000XPain Medicine Physician63321MN

General Provider Information

NPI Number : 1972977098
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MICHAEL HAGEDORN M.D.
Provider Business Mailing Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 507-284-2511
Fax Number :
Provider Business Practice Location Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 507-284-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2015
Last Update Date : 11/14/2022

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