Healthcare Provider Details

I. General information

NPI: 1003505272
Provider Name (Legal Business Name): KRISTIN LYNN HAGAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN LYNN SPELDE

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 BECKER DR
ALLENDALE MI
49401-8616
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-3900
  • Fax: 616-252-3920
Mailing address:
  • Phone: 616-252-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301518053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: