1780603746 NPI number — MICHAEL EDWARD HAGENSEE MD PHD

Table of content: BETTY ALLEN MD (NPI 1043745755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780603746 NPI number — MICHAEL EDWARD HAGENSEE MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGENSEE
Provider First Name:
MICHAEL
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780603746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
533 BOLIVAR ST
Provider Second Line Business Mailing Address:
LSUHSC
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-903-6569
Provider Business Mailing Address Fax Number:
504-903-6842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 S ROMAN ST
Provider Second Line Business Practice Location Address:
LSUHSC
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112-3095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-903-6569
Provider Business Practice Location Address Fax Number:
504-903-6842
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  12021R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53234 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02558050 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1532347 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80387 . This is a "LSUHSC" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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