Healthcare Provider Details

I. General information

NPI: 1285790337
Provider Name (Legal Business Name): ANDREA RUTH HAGEMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV OBGYN GYNECOLOGIC ONCOLOGY, STE 13C
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3181
  • Fax: 314-362-2893
Mailing address:
  • Phone: 314-362-3181
  • Fax: 314-362-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2011005770
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number2011005770
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: