MEDICARE: DR. KELLY MCGINNIS HAGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	73679	CT
2	207R00000X	Internal Medicine Physician	73679	CT

General Provider Information

NPI Number	:	1073003224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MCGINNIS HAGER MD

Provider Business Mailing Address
First Line	:	155 VAN GORDON ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1709
Country	:	US
Telephone Number	:	833-633-8846
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 VAN GORDON ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1709
Country	:	US
Telephone Number	:	833-633-8846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	10/17/2023

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