Healthcare Provider Details

I. General information

NPI: 1295791036
Provider Name (Legal Business Name): LISA ANN HAGLUND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 EDEN & ALBERT SABIN # 405
CINCINNATI OH
45267-0405
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-6868
  • Fax: 513-584-6040
Mailing address:
  • Phone: 513-585-5504
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35-062037
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-062037
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200120010
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier64868003
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer
# 3
Identifier440000804
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAIL ROAD MEDICARE
# 4
Identifier0861812
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: