Healthcare Provider Details

I. General information

NPI: 1073003224
Provider Name (Legal Business Name): KELLY MCGINNIS HAGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 VAN GORDON ST
LAKEWOOD CO
80228-1709
US

IV. Provider business mailing address

155 VAN GORDON ST
LAKEWOOD CO
80228-1709
US

V. Phone/Fax

Practice location:
  • Phone: 833-633-8846
  • Fax:
Mailing address:
  • Phone: 833-633-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number73679
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73679
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: