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NPI Code Detail

MEDICARE: DR. REBECCA HAGERTY DO

MEDICARE: DR. REBECCA HAGERTY DO
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
1207QA0505XAdult Medicine PhysicianRV013390MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568463057
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA HAGERTY DO
Provider Business Mailing Address
First Line : 1200 SIXTH ST
Second Line : STE 400
City : TRAVERSE CITY
State : MI
Zip : 49684-2369
Country : US
Telephone Number : 231-392-0650
Fax Number : 231-392-0665
Provider Business Practice Location Address
First Line : 1200 SIXTH ST
Second Line : STE 400
City : TRAVERSE CITY
State : MI
Zip : 49684-2369
Country : US
Telephone Number : 231-392-0650
Fax Number : 231-392-0665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 01/08/2008

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Directions to “ DR. REBECCA HAGERTY DO” Practice Location

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