MEDICARE: DR. JOHN E HATEGAN 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	207Q00000X	Family Medicine Physician	01052717A	IN

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	:	1902894546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E HATEGAN MD

Provider Business Mailing Address
First Line	:	101 CONNIE AVE
Second Line	:
City	:	SALEM
State	:	IN
Zip	:	47167-2305
Country	:	US
Telephone Number	:	812-883-9121
Fax Number	:	812-883-2161

Provider Business Practice Location Address
First Line	:	102 CONNIE AVE
Second Line	:	SUITE 206
City	:	SALEM
State	:	IN
Zip	:	47167-2311
Country	:	US
Telephone Number	:	812-883-9121
Fax Number	:	812-883-2161

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	08/12/2022

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