Provider Demographics
NPI:1336116367
Name:HAGAN, STEVEN V (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:V
Last Name:HAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 144TH ST
Mailing Address - Street 2:STE 212
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5253
Mailing Address - Country:US
Mailing Address - Phone:402-637-0400
Mailing Address - Fax:402-637-0401
Practice Address - Street 1:2725 S 144TH ST
Practice Address - Street 2:#110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5243
Practice Address - Country:US
Practice Address - Phone:402-637-0400
Practice Address - Fax:402-637-0401
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE19572207XX0005X
IA30699207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF56954Medicare UPIN
NE264661Medicare PIN