Healthcare Provider Details

I. General information

NPI: 1720075203
Provider Name (Legal Business Name): DANIEL J HAGEMAN RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10222 MONROVIA ST
LENEXA KS
66215-1980
US

IV. Provider business mailing address

10222 MONROVIA ST
LENEXA KS
66215-1980
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-4733
  • Fax: 913-599-4866
Mailing address:
  • Phone: 913-599-4733
  • Fax: 913-599-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: