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General NPI Number Information
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NPI Number | 1710514500
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Entity Type | Individual
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Provider Name | THOMAS KENNEY HAGERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 4260 PLYMOUTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48109-2700
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Country | US
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Telephone | 217-494-2440
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Fax |
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Provider Business Mailing Address
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Address Line | 4260 PLYMOUTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48109-2700
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Country | US
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Telephone | 217-494-2440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301513487
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301513487
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License Number State | MI
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