Healthcare Provider Details

I. General information

NPI: 1780791699
Provider Name (Legal Business Name): CARRIE A. HAGEMANN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W. MARKET SUITE B
OSAGE CITY KS
66523
US

IV. Provider business mailing address

131 W. MARKET SUITE B
OSAGE CITY KS
66523
US

V. Phone/Fax

Practice location:
  • Phone: 785-528-3161
  • Fax: 785-528-4045
Mailing address:
  • Phone: 785-528-3161
  • Fax: 785-528-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-32170
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: