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General NPI Number Information
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NPI Number | 1811573256
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Entity Type | Individual
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Provider Name | MATTHEW R HAGERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 1460 N HALSTED ST STE 504
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City | CHICAGO
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State | IL
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Zip | 60642-2613
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Country | US
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Telephone | 312-926-3627
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Fax | 312-926-3231
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Provider Business Mailing Address
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Address Line | 1215 LEE ST MAIL STOP 800499
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-5348
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036169109
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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