Provider Demographics
NPI:1033185848
Name:HAGEN, KARL MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:MATTHEW
Last Name:HAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SE 2ND CT
Mailing Address - Street 2:SUITE 1144
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3621
Mailing Address - Country:US
Mailing Address - Phone:954-703-6038
Mailing Address - Fax:954-703-6037
Practice Address - Street 1:600 SE 2ND CT
Practice Address - Street 2:SUITE 1144
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3621
Practice Address - Country:US
Practice Address - Phone:954-703-6038
Practice Address - Fax:954-703-6037
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME785242084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257887500Medicaid
FL47258OtherBCBS NUMBER
FL47258OtherBCBS NUMBER
FL47258OtherBCBS NUMBER
FL47258ZMedicare ID - Type UnspecifiedLAKE COUNTY MEDICARE