Healthcare Provider Details

I. General information

NPI: 1225042492
Provider Name (Legal Business Name): MICHAEL ANTHONY HAGMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE # 2309
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

200 HENRY CLAY AVE # 2309
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-4297
  • Fax: 504-894-5563
Mailing address:
  • Phone: 504-897-4297
  • Fax: 504-894-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number017685
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number017685
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: