MEDICARE: ALAN KYLE HAGSTROM 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	207L00000X	Anesthesiology Physician	23903	AZ
2	208VP0000X	Pain Medicine Physician	ME114651	FL
3	2084P0800X	Psychiatry Physician	ME114651	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1619947801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN KYLE HAGSTROM MD

Provider Business Mailing Address
First Line	:	250 PARK SHORE DR APT 202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3440
Country	:	US
Telephone Number	:	239-404-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 PANTHER LN
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-7874
Country	:	US
Telephone Number	:	239-404-3379
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/21/2022

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